甲状腺激素与脑钠肽检测在老年心力衰竭患者中的临床研究

目的：探讨老年慢性心力衰竭（CHF）患者甲状腺激素（TH）水平、脑钠肽（BNP）、左室射血分数与心功能的变化及TH、BNP与心血管事件的相关性。方法：选择符合CHF诊断标准的186例老年患者，依照NYHA心功能分级为Ⅰ级（对照组）、Ⅱ级、Ⅲ级及Ⅳ级为CHF组，测定血清中总三碘甲状腺原氨酸（T3）、总甲状腺素（T4）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺素（TSH）及BNP水平，超声心电图测定左室射血分数（LVEF），比较各组检测指标变化及与心功能的关系。同时根据住院期间是否发生心血管事件分为事件组、非事件组，比较两组间各检测指标的变化。结果：（1）不同心功能组：心力衰竭组中随着心功能分级的增加，FT3、T3及LVEF逐渐降低，低于对照组，差异均有统计学意义（P﹤0.05）；BNP逐渐升高，高于对照组，差异均有统计学意义（P﹤0.05）。（2）心血管事件组和非事件组比较：FT3、T3显著降低，BNP显著升高，差异均有统计学意义（P﹤0.05）。（3）血BNP与T3、FT3呈显著负相关，LVEF与T3、FT3呈显著正相关。结论：动态检测TH及BNP水平的变化可作为判断心力衰竭严重程度和影响预后的指标。

Clinical Study on Thyroid Hormone and Brain Natriuretic Peptide Detection in Elderly Patients with Chronic Heart Failure

Objective：To investigate the changes of thyroid hormone（TH）,brain natriuretic peptide（BNP）,left ventricu-lar ejection fraction（LVEF）and cardiac function,and the correlation of TH,BNP and cardiovascular events in elderly patients with chronic heart failure（CHF）. Methods：One hundred and eighty - six elderly patients were divided into 4 groups,the control group（gradeⅠ）and the chronic CHF group（consisting of gradeⅡ,Ⅲ and Ⅳ groups）according to the New York Heart Association（NYHA）cardiac functional standard. The serum levels of free triiodothyronine（FT3 ）, free thyroxine（FT4 ）,total triiodothyronine（T3 ）,total thyroxine（T4 ）,thyroid stimulating hormone（TSH）and BNP were measured in patients. The value of LVEF was detected by echocardiography. The changes of indexes in these groups were compared and the relationship was observed between the indexes and cardiac function in patients. And these patients were divided into 2 groups,the event group and the non-event group according to the occurrence of cardiovascular events. The indexes of two groups were compared. Results：（1）Levels of T3 ,FT3 ,LVEF decreased as the degree of chronic heart failure increased and were significantly lower in CHF group than those of control group,the differences were statistically significant（P ﹤ 0. 05）. Levels of BNP increased as the degree of chronic heart failure increased and were significantly higher in CHF group than those of control group,the differences were statistically significant（P ﹤ 0. 05）.（2）Levels of T3 ,FT3 were significantly lower in event group than those of non-event group,the differences were statistically significant （P ﹤ 0. 05）. Levels of BNP were significantly higher in event group than those of non - event group,the differences were statistically significant（P ﹤ 0. 05）.（3）BNP was negatively correlated with T3 ,FT3 . LVEF was positively correlated with T3 and FT3 . Conclusion：The dynamic changes of the thyroid hormones and BNP