血浆甲状腺激素水平变化对心力衰竭治疗的指导意义

The levels change of thyroid hormones in the treatment of heart failure

目的探讨不同心功能分级患者治疗期间血浆甲状腺素水平的变化趋势与差异。方法选择2015年1~12月我院收治的住院患者135例,其中充血性心衰患者103例,非心脏病患者32例。分为心衰组(包括Ⅱ、Ⅲ、Ⅳ、级)及非心脏病组,分别在入院、治疗1周、治疗2周进行甲状腺激素、NT-proBNP、EF值的检测,对检测结果进行对比分析。结果心衰组与对照组之间,TSH、FT_4在血浆中的浓度无统计学差异;随着心衰程度的增加,血浆FT_3浓度缓慢下降,NT-proBNP浓度缓慢增加,EF值逐渐降低(P<0.05)。治疗后患者心功能好转,体内FT_3浓度明显上升,NT-proBNP浓度逐渐恢复,EF值增加(P<0.05)。结论规范化治疗心衰后,血浆FT_3浓度逐渐上升,但是不同心功能分级的患者FT_3恢复水平不一致,甲状腺激素水平可作为判断心功能分级和恢复的指标之一。

Objective To investigate the changes and difference of thyroid hormones in resident patients with different NYHA cardiac function grades during medical treatment. Methods One hundred and thirty-five patients with heart failure were were divides into two groups,termed as CHF group（103 patients with congestive heart failure） and Control group（32 patients without cardiac diseases）. NT-proBNP, thyroid hormones and EF value were measured at the start of medical treatment, one week after treatment and two weeks after treatment. Results There was no statistic difference in TSH and FT4 between CHF group and Control group. Decreased FT3,increased NT-proBNP and decreased EF occurred in patients （P 〈0. 05） ,when cardiac function deteriorated. However, standard treatment for 1 week or 2 weeks in patient with heart failure could decrease the NT-proBNP concentration,increase FT3 and EF （P 〈 0. 05 ）. Conclusion FT3 in patients with congestive heart failure recovers gradually after standard medical treatment, but the FT3 concentration varies among patients with different NYHA cardiac function grades. What, s more,the increased FT3 facilitate the recovery of heart function.