小剂量左旋甲状腺素治疗成人心脏手术后低T3综合征的临床研究

Efficacy of low-dose levothyroxine on low T3 syndrome patients after cardiac surgery

目的研究小剂量左旋甲状腺素替代治疗对伴有低T3综合征(LT3S)的心脏术后患者的疗效及其短期预后的影响。方法回顾性分析2019年5月至2022年3月上海交通大学医学院附属新华医院心胸外科57例心脏术后出现低T3综合征患者,根据是否给药分为对照组(28例)和治疗组(29例),对照组予常规治疗,治疗组在常规治疗基础上口服小剂量左旋甲状腺素,分析比较两组患者术后心功能变化、并发症发生率及短期预后的差异。结果治疗组患者精神、饮食均较对照组改善明显,平均T3由(0.50±1.74)nmol/L上升至(1.33±0.48)nmol/L,FT3由(2.54±0.63)pmol/L上升至(4.11±0.40)pmol/L,明显高于对照组(0.97±0.47)nmol/L、(3.44±0.74)pmol/L(P<0.001),左心室射血分数(LVEF)由(45.24±7.94)%上升至(52.45±6.19)%,明显高于对照组(45.64±6.01)%(P<0.001),N末端B型利钠肽原(NT-proBNP)由(2610±1202)ng/L下降至(1253±318)ng/L,明显低于对照组(1710±666)ng/L(P=0.002)。同时,治疗组ICU滞留时间(12.6±5.7)d,及术后住院时间(21.0±6.6)d均短于对照组(P<0.05),并发症发生率低于对照组。结论小剂量左旋甲状腺素口服可提高伴有低T3综合征的心脏术后患者术后心脏功能恢复、减少术后并发症、改善患者预后。

Objective To study the efficacy and short-term prognosis of low-dose levothyroxine in the postoperative cardiac patients with low triiodothyronine syndrome(LT3S).Methods A total of 57 patients with low triiodothyronine syndrome after the cardiac surgery were divided into the control group(N=28)and study group(N=29)according to wether use low-dose levothyroxine.Postoperative left ventricular ejection fractions(LVEF),N-terminal brain natriuretic peptide(NT-proBNP),thyroid function,complication rates,intensive care unit(ICU)and hospitalization time were compared between the two groups.Results Patients in the study group showed better mental statement and appetite than those in the control group.The averaged T3 increased from(0.50±1.74)nmol/L to(1.33±0.48)nmol/L and with FT3 increased from(2.54±0.63)pmol/L to(4.11±0.40)pmol/L,which were both significantly higher than those in the control group(0.97±0.47)nmol/L,(3.44±0.74)pmol/L,P<0.001).LVEF increased from(45.24±7.94)%to(52.45±6.19)%,significantly higher than that in the control group(45.64±6.01)%,P<0.001).NT-proBNP decreased from(2610±1202)ng/L to(1253±318)ng/L,which was significantly lower than that in the control group(1253±318)ng/L,P=0.002).Compared to the control group,both the ICU stay time(12.6±5.7)d and post-operation hospitalization time(21.0±6.6)d of the study group were significantly shorter(P<0.05);the complication rates were lower too(P>0.05).Conclusion In the postoperative cardiac patients with low triiodothyronine syndrome,low-dose levothyroxine can improve postoperative cardiac function recovery,reduce postoperative complications and improve patient prognosis.