胺碘酮片对老年患者甲状腺功能和形态的影响

目的 结合尿碘水平探讨胺碘酮片对老年心律失常患者甲状腺功能及形态的影响.方法 选取70例老年心律失常患者,分为胺碘酮片治疗组和普罗帕酮片对照组,各35例.所有患者均于治疗前及治疗1、3、6个月后测定总四碘甲状腺原氨酸（TT4）、总三碘甲状腺原氨酸（TT3）、游离甲状腺原氨酸（FT4）、游离三碘甲状腺原氨酸（FT3）、促甲状腺激素（TSH）、甲状腺抗过氧化物酶抗体（TPOAb）和甲状腺球蛋白抗体（TGA）含量;同时于治疗前及治疗6个月后B超检查甲状腺形态及测定射血分数、尿碘含量.结果 治疗组治疗后尿碘水平明显高于治疗前（P〈0.05）,而且较之对照组治疗后亦明显升高（P〈0.05）.治疗组在治疗过程中出现亚临床甲状腺功能减退3例,亚临床甲状腺功能亢进1例;对照组出现亚临床甲状腺功能减退1例,两组患者甲状腺功能异常发生率的差异无统计学意义（P＞0.05）.两组患者治疗前后甲状腺素水平的差异均无统计学意义（P＞0.05）.治疗组甲状腺B超检查异常2例,均为甲状腺小结节;对照组未发现甲状腺B超检查异常者.结论 胺碘酮片使用者体内碘含量明显高于普罗帕酮片使用者,甲状腺功能异常及甲状腺结节发生率也有所增高,但差异并无统计学意义,但也可能与本研究时间较短、样本量不大有关.

Effect of amiodarone on thyroid functions and urinary iodine levels in elder patients with arrhythmia

Objective To investigate the effect of amiodarone on urinary iodine levels and thyroid functions in elderly patients with arrhythmia. Methods Seventy elderly patients with arrhythmia were treated with amiodarone or propafenone （n=35 in each group）. Thyroid gland function, ultrasonography and heart injection fraction were examined; urinary iodine excretion, TPOAb and TGA were mearsured before and 1, 3 and 6 months after treatment. Results Urinary iodine excretion was significantly higher in amiodarone group after treatment （P〈0.05） and also higher than that of propafenone group （P〈0.05）. Four cases of subclinical thyroid dysfunction and 2 cases of thyroid nodules were detected in amiodarone group, while there was 1 subclinical thyroid dysfunction case and no case of thyroid nodules in propafenone group. Conclusion The urinary iodine excretion is higher in patients receiving amiodarone treatment, but there are no differences in other parameters between amiodarone and propafenone treatment in elderly patients with arrhythmia.