甲状腺功能亢进性心脏病病人左心室结构与功能变化

目的探讨甲状腺功能亢进（甲亢）性心脏病病人左心室结构与功能的改变和早期诊断。方法应用彩色多普勒超声心动图测量96例甲亢病人（其中65例为甲亢性心脏病）和30例正常人（对照组）左心室舒张末期内径（LV）、舒张末期左心室后壁及室间隔的厚度（IVS、LVPW）、收缩末期左心房横径（LA）、左心室舒张早期最大血流速度（E）及舒张晚期最大血流速度（A）、二尖瓣最大血流速度、左心室射血分数（EF）,计算左心室质量（LVM）、质量指数（LVMI）及舒张早晚期的最大血流速度比值（E/A）。结果与单纯甲亢和对照组比较,甲亢性心脏病病人早期LVMI升高,而E/A值降低,差异有显著性（F=5.47、5.03,q=4.93-5.10,P〈0.01）;甲亢性心脏病早期EF与对照组比较无显著性差异（P〉0.05）,而晚期EF低于对照组,差异有显著性（F=5.03,q=4.87,P〈0.01）;单纯甲亢病人EF高于对照组（q=5.02,P〈0.01）。结论甲亢病人左心室收缩功能增强,甲亢性心脏病病人早期出现左心舒张功能不全,晚期出现收缩功能不全;LVMI结合二尖瓣血流频谱E/A值可早期诊断甲亢性心脏病。

THE CHANGES OF LEFT VENTRICULAR STRUCTURE AND FUNCTION IN THYROTOXIC HEART DISEASE

Objective To study changes of structure and function of the left ventricle in thyrotoxic heart disease. Methods By using color Doppler ultrasonography, 96 patients and 30 healthy volunteers were measured for end diastole diameter and thickness of end-diastole posterior left ventricle and interventricular septum, end-systole diameter of left atrium, left ventricular ejection fraction （EF）, the peak value of mitral annular early diastolic velocity （E） and late diastolic velocity （A）, left ventricu lar mass and mass index （LVMI） and E/A ratio. Results A comparison between patients with early thyrotoxic heart disease and those with simple hyperthyroidism and normal controls showed LVMI was high （F= 5.47,q =4. 93- 5. 04, P〈0.01）, but E/A was low （F= 5.03,q= 4. 98-5. 10, P（0. 01）. The difference of EF was not significant between patients with early thyrotoxic heart disease and the normal controls （P;〉0.05）. EF of the patients with thyrotoxic heart disease in late stage was lower than the normal ones （q=4.87,P〈0.01）, and EF in those with simple hyperthyroidism was higher （q= 5. 02, P〈0. 01）. Conclusion The systolic function of left ventricle in patients with hyperthyroidism was stronger and those with thyrotoxic heart disease was di astolic insufficiency in early stage, and later showed systolic dysfunction. Thyrotoxic heart disease can be early diagnosed by combination of LVMI and E/A.