甲亢性心脏病临床特征和治疗方法的回顾性研究

A retrospective cohort study exploring clinical characteristics and treatment of hyperthyroid cardiopathy

目的回顾性分析49例甲状腺功能亢进(甲亢)性心脏病患者的临床特征和诊疗经过,探讨甲亢性心脏病的诊疗方法。方法纳入2016年1月至2021年12月于上海交通大学医学院附属上海市第一人民医院内分泌代谢科住院成功救治并完整随访的甲亢性心脏病患者49例(HC组),以Graves病无心脏病患者85例为对照(GD组)。比较2组患者基线病史信息、实验室检查和心脏超声等指标,总结HC组患者治疗前后甲状腺激素与心脏指标的差异以及β受体阻滞剂在不同类型HC组(房颤和心力衰竭)患者治疗中应用的剂量。结果HC组较GD组患者年龄更大、甲亢病程更长(P<0.001,P=0.002);2组除反三碘甲状腺原氨酸(rT_(3))外其余甲状腺激素水平差异均无统计学意义。且年龄和rT_(3)是甲亢性心脏病的独立危险因素,rT_(3)与脑钠肽、肺动脉收缩压、左心房内径、左室收缩末内径(LVDs)呈线性正相关(r=0.352,P<0.001;r=0.392,P=0.019;r=0.202,P=0.029;r=0.242,P=0.028)。HC组患者经放射性碘(41/49)或抗甲状腺药物(8/49)治疗2.87(1.63,5.53)个月后游离三碘甲状腺原氨酸(FT_(3))水平恢复正常,在5.00(1.25,8.00)个月后脑钠肽、左心房内径、LVDs、肺动脉收缩压较治疗前明显改善。甲亢性心力衰竭与房颤均应用非选择性β受体阻滞剂,且日剂量差异无统计学意义[(86.52±47.83)mg对(88.67±47.19)mg,P>0.05]。结论rT_(3)水平可能为临床上甲亢性心脏病的生物标志物,提示甲亢病情的严重程度。β受体阻滞剂在治疗房颤和心力衰竭类型的甲亢性心脏病患者中均起到重要作用。

Objective To retrospectively summarize the clinical characteristics and treatment of 49 patients with hyperthyroid cardiopath and to explore the diagnosis and treatment methods of hyperthyroid cardiopathy.Methods A total of 49 patients with hyperthyroid cardiopath(HC group)who were successfully treated and followed up in the Department of Endocrinology,Shanghai General Hospital,Shanghai Jiao Tong University School of Medicine,from January 2016 to December 2021 were collected,and 85 cases of Graves′disease without heart disease were collected as the control group(GD group).The medical history,laboratory tests,and echocardiographic parameters of the two groups were compared.Differences in thyroid and cardiac indicators before and after treatment in the HC group were summarized,along with the dosage of β-receptor blockers used in treating different types of conditions(atrial fibrillation and heart failure.Results Patients in the HC group were older and had a longer duration of hyperthyroidism than those in the GD group(P<0.001,P=0.002).There were no significant differences in thyroid hormone levels between the two groups except for reverse triiodothyronine(rT_(3)).Age and rT_(3) were independent risk factors of hyperthyroid cardiopathy.rT_(3) level was linearly positively correlated with brain natriuretic peptide,systolic pulmonary artery pressure,left artrium diamete(LAD)and left ventricular end-systolic diameter(LVDs;r=0.352,P<0.001;r=0.392,P=0.019;r=0.202,P=0.029;r=0.242,P=0.028).In patients of HC group,free triiodothyronine(FT_(3))level returned to normal range after 2.87(1.63,5.53)months of treatment with radioiodine(41/49)or antithyroid drugs(8/49),while brain natriuretic peptide,LAD,LVDs,and systolic pulmonary artery pressure declined after 5.00(1.25,8.00)months of treatment.Non-selectiveβ-receptor blockers were used for both hyperthyroid heart failure and atrial fibrillation,and there was no statistically significant difference in dosage[(86.52±47.83)mg vs(88.67±47.19)mg,P>0.05].Conclusions rT_(3)may be a biomarker of hyperthyroid cardiopath and indicate the severity of hyperthyroidism.β-receptor blockers are crucial in treating patients with hyperthyroidism who develop atrial fibrillation and heart failure.