碘普罗胺对合并T3减低的稳定型心绞痛患者甲状腺功能的影响

The influence of iopromide on thyroid function in stable angina pectoris patients with low triiodothyronine

目的:探讨冠心病介入术前后合并三碘甲状腺原氨酸(T3)减低的稳定型心绞痛患者甲状腺功能及自身抗体的变化。方法:选取合并T3减低、甲状腺素(T4)与促甲状腺激素(TSH)正常的稳定型心绞痛患者154例,分别于术前及术后1 d、1个月、3个月、6个月测定游离T3(FT3)、反T3(rT3)、游离T4(FT4)、T3总量(TT3)、T4总量(TT4)与TSH,术前及术后6个月测定甲状腺过氧化物酶抗体(TPOAB)、甲状腺球蛋白抗体(TGAB)。结果:154例患者中,术后1 d出现甲状腺功能减低(甲减)6例(3.9%)、亚临床甲状腺功能减低(亚甲减)30例(19.5%),术后1个月出现甲减6例(3.9%)、亚甲减6例(3.9%)、亚临床甲状腺功能亢进(亚甲亢)18例(11.7%),术后6个月出现亚甲减6例(3.9%)、亚甲亢23例(14.9%)。术后1 d及1、3、6个月时TT3、TSH水平均较术前显著改变(均P<0.005),rT3水平与术前比较差异无统计学意义。分组显示,高剂量组(碘普罗胺用量≥100 ml者113例)的T3水平在术后1 d及3个月时改变较低剂量组(用量<100 ml者41例)显著。术后6个月时TGAB及TPOAB平均水平均较术前显著降低(均P<0.001)。随访中未见需要药物干预的严重甲状腺功能异常者。结论:冠心病介入诊治过程中单次大剂量碘负荷增加T3减低患者出现一过性甲状腺功能异常的风险,但未出现需要药物干预的严重甲状腺功能异常者。

Objective:To explore the effect of iodinated contrast on thyroid function and auto-antibodies after diagnosis and treatment of coronary heart disease in patients with low triiodothyronine(T3).Method:A total of 154 stable angina pectoris patients with normal thyroid-stimulating hormone(TSH)and low T3 were enrolled.The blood free T3(FT3),reverse T3(rT3),free thyroxine(FT4),total T3(TT3),total thyroxine(TT4)and TSH were measured before angiography and 1 day,1 month,3 months and 6 months after the therapy.The blood thyroid peroxidase antibody(TPOAB)and thyroglobulin antibody(TGAB)were measured before angiography and 6 months after the operation.Result:Hypothyroidism occurred in 6 cases(3.9%)and subclinical hypothyroidism occurred in 30 cases(19.5%)one day after operation.Hypothyroidism occurred in 6 cases(3.9%),subclinical hypothyroidism occurred in 6 cases(3.9%),and subclinical hyperthyroidism occurred in 18 cases(11.7%)one month after operation;Subclinical hypothyroidism occurred in 6 cases(3.9%)and subclinical hyperthyroidism occurred in 23 cases(14.9%).The levels of TT3 and TSH changed statistically after 1 day,1,3 and 6 months after operation(all P<0.005).The level of rT3 showed no significant change at 1,3 and 6 months after operation.The level of T3 in the high dose group(113 cases with iopromide dosage≥ 100 ml)changed more significantly than that in the low dose group(41 cases with iopromide dosage< 100 ml)at 1 day and 3 months after operation.The levels of TGAB and TPOAB decreased statistically 6 months after operation(both P<0.001).No patient with severe thyroid dysfunction occurred during follow-up.No severe thyroid dysfunction requiring drugs was found during follow-up.Conclusion:In the diagnosis and treatment of coronary heart disease,a single high-dose of iopromide may increase the risk of transient thyroid dysfunction in patients with low T3 but does not cause severe thyroid dysfunction which requires drug intervention.