不稳定型心绞痛、心肌梗死患者甲状腺激素水平的测定及其临床意义

目的评价不稳定型心绞痛(UA)及急性心肌梗死(AMI)、陈旧性心肌梗死(OMI)患者血清甲状腺激素水平变化的临床意义。方法选择71例正常人群为对照组,170例冠心病患者作为病例组,并分成三个亚组,其中患者52例,OMI患者50例,UA患者68例。测定血清甲状腺激素水平。结果 AMI急性心肌梗死组与对照组相比血清总三碘甲状腺原氨酸(TT3)下降、游离三碘甲状腺原氨酸(FT3)下降有统计学意义(P<0.01),总甲状腺素(TT4)、游离甲状腺素(FT4)水平有下降趋势。UA组与对照组比血清FT3下降有统计学意义(P<0.05)。三个亚组间在单支、双支、多支血管病变间比较,血清TT3、FT3均呈下降趋势,AMI在多支病变时与UA、OMI相比血清FT3下降有统计学意义(P<0.05)。结论患者血清TT3、FT3水平反应急性心肌梗死、不稳定型心绞痛病情及冠脉血管病变的严重程度,病情越严重,下降越明显。     

慢性阻塞性肺疾病患者血清甲状腺激素的变化及临床意义

目的探讨慢性阻塞性肺疾病（COPD）患者血清中甲状腺激素的变化及临床意义。方法采用放射免疫法（RIA）检测46例COPD患者及32例正常对照血清中三碘甲状腺原氨酸（TT3）、甲状腺素（TT4）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺素（TSH）及反三碘甲状腺原氨酸（rT3）6项指标。结果COPD患者的TT3、TT4、FT3水平显著降低，随着呼吸衰竭，甲状腺激素水平进一步降低，FT4也明显低于对照组，rT3则显著高于对照组，TSH无明显改变。结论监测COPD患者血清甲状腺激素水平可判断COPD的危重程度及估计预后。     

冠心病患者血清甲状腺激素和细胞因子的变化及临床意义

目的观察冠心病患者血清甲状腺激素及细胞因子的变化,并探讨其相关性。方法应用放射免疫分析法检测正常对照者、稳定型心绞痛患者、急性心肌梗死患者血清游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺刺激激素（TSH）、反三碘甲状腺原氨酸（rT3）、肿瘤坏死因子α（TNF-α）及IL-6的浓度,并进行比较。对急性心肌梗死患者血清FT3、rT3与TNF-α进行相关性分析。结果与正常对照比较,急性心肌梗死、稳定型心绞痛患者的FT3含量降低,以急性心肌梗死患者为著;rT3、TNF-α、IL-6含量升高（P均〈0.05）。急性心肌梗死患者血清中FT3与TNF-α含量呈显著负相关（r=-0.54,P〈0.05）;rT3与TNF-α含量呈显著正相关（r=0.62,P〈0.05）。结论冠心病患者甲状腺功能处于较低水平,而细胞因子TNF-α、IL-6处于较高的水平,TNF-α、IL-6的改变直接参与了正常甲状腺病态综合征的产生。     

老年2型糖尿病患者甲状腺激素水平变化及其临床意义

目的探讨老年2型糖尿病(T2DM)患者血清甲状腺激素水平检测的临床意义。方法老年T2DM患者200例依据病情分为轻症组108例,重症组92例,于入院后第2天空腹抽肘静脉血,同时测定三碘甲状腺氨酸(T3)、甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)及反三碘甲腺原氨酸(rT3)水平及T细胞亚群,并与正常对照组作比较。结果与对照组比较,重症组空腹胰岛素、空腹血糖(FPG)、空腹C肽及糖化血红蛋白水平、rT3水平和CD8均明显增高(P<0.05),血清FT3、FT4水平、CD4/CD8比值明显减低;轻症组FPG、空腹C肽及糖化血红蛋白水平明显增高(P<0.05),血清FT3水平明显减低(P<0.05)。结论老年T2DM不同血糖水平的甲状腺激素水平及T细胞亚群水平有相关性,其定期检测能早期诊断T2DM相关免疫紊乱疾病,及时了解患者机体状态和预后。     

老年心功能不全合并甲状腺功能减退3例报道

充血性心力衰竭(CHF)患者体内存在着甲状腺激素代谢异常,表现为血清总三碘甲腺原氨酸(T3)水平降低,血清总甲状腺素(T4)水平降低或正常,血清游离三碘甲腺原氨酸(FT3)水平升高以及促甲状腺激素(TSH)水平正常.严重程度与心力衰竭的严重程度密切相关.而甲状腺功能减退患者由于甲状腺激素分泌不足又可加重心肌病变,心肌收缩力减弱,使得心力衰竭反复发作.     

非体外循环下冠状动脉搭桥术后甲状腺激素水平的变化

目的:评价非体外循环下冠状动脉搭桥术后甲状腺激素水平的变化,研究其临床意义。方法:选取我院2006年6月至2006年12月非体外循环下冠状动脉搭桥术患者8例A组,同时选取体外循环(cardiopulmonary bypass,CPB)下冠状动脉搭桥术患者15例为B组,分别测定2组术前及术后一周血浆甲状腺激素和促甲状腺激素(TSH)的浓度。结果:在CPB下冠状动脉搭桥术的患者其三碘甲状腺原氨酸(T3)、游离三碘甲状腺原氨酸(FT3)术后一周呈下降低趋势P<0.05,甲状腺素(T4)、游离甲状腺素(FT4)和TSH手术前后差异无显著性,而非CPB下冠状动脉搭桥术的患者T3和FT3术后一周略有下降,但与术前相比差异无显著性(P>0.05)。结论:在CPB下冠状动脉搭桥手术对甲状腺激素的代谢有影响,术后表现为低T3综合征,而非CPB下冠状动脉搭桥手术对甲状腺激素水平的影响较小。提示非CPB下冠状动脉搭桥手术对机体垂体-甲状腺轴的影响相对小、安全性高、预后更好。     

不同心功能分级慢性心力衰竭患者甲状腺激素改变的临床意义

目的 探讨不同心功能分级慢性心力衰竭患者血清甲状腺激素水平的改变及其临床意义.方法 采用放射免疫分析法检测43例慢性心力衰竭患者血清甲状腺激素水平的变化,并以同期健康体检者26名血清标本作为对照组.结果 病例组血清游离三碘甲状腺原氨酸(FT3)水平明显低于对照组(P<0.05),血清仅三碘甲状腺原氨酸(rT3)水平高于对照组(P<0.05);病例组不同心功能分级患者血清FT3水平均存在差异;心功能受损程度与FT3下降水平存在正相关.结论 慢性心力衰竭时甲状腺激素的代谢发生了明显的变化,而且心功能程度与甲状腺激素水平相关,激素含量的改变与疾病严重程度存在一定相关性.     

咳嗽变异性哮喘患者血浆甲状腺激素含量研究

目的探讨咳嗽变异性哮喘(CVA)患者急性加重期及缓解期血浆甲状腺激素含量变化及其临床意义。方法应用电化学发光法测定48例CVA患者急性加重期和缓解期及35例健康志愿者血浆三碘甲状腺原氨酸(TT3)、甲状腺素(TT4)、促甲状腺素(TSH)、血浆三碘游离甲状腺素(FT3)和游离甲状腺素(FT4)的含量。同时检测动脉血中氧分压(PaO2),并分析CVA患者缺氧程度与甲状腺激素水平的相关性。结果 CVA急性加重期和缓解期TT3、FT3、FT4含量与对照组相比明显降低(P0.01,P0.05);CVA患者急性加重期TT3、FT3和FT4含量显著低于缓解期(P0.05)。CVA患者急性发作期血浆TT3、FT3、FT4水平与氧分压(PaO2)呈显著的正相关。结论 CVA患者血浆TT3、FT3、FT4水平明显低于正常人,缺氧是导致CVA患者甲状腺激素含量变化的重要因素之一。     

不同程度认知障碍患者血清甲状腺激素水平的变化及意义

目的 探讨不同程度认知障碍患者的血清甲状腺激素水平情况及其与认知功能之间的关系.方法 检测轻度认知功能障碍组(MCI组)、阿尔茨海默病组(AD组)和认知正常者(NC组)3组甲状腺激素水平情况和简易精神状态检查、临床痴呆评定量表测评.结果 AD组简易精神状态检查量表(MMSE)评分与MCI组、NC组比较差异有统计学意义(P<0.01),血清促甲状腺激素(TSH)、促甲状腺原氨酸(T4)水平3组比较差异无统计学意义(P>0.05).AD组、MCI组血清三碘甲状腺原氨酸(T3)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平低于对照组(P<0.01),AD组和MCI组之间血清T3、FT3、FT4水平比较差异无统计学意义(P>0.05).MCI组与AD组血清T3、FT3、FT4水平与MMSE评分呈正相关(P<0.05).结论 AD患者和MCI患者存在着甲状腺激素水平的异常,并且与认知障碍严重程度存在相关性.甲状腺激素水平可能为AD和MCI患者的临床诊断指标.     

老年患者甲状腺激素水平与冠状动脉病变严重程度的临床研究

目的:探讨甲状腺功能正常的老年患者甲状腺激素水平与冠状动脉病变及其严重程度的关系。方法:回顾143例因胸痛于我院行冠状动脉造影检查的甲状腺功能正常老年患者,根据冠状动脉造影结果分为冠心病组和无冠心病组,再计算所有患者冠状动脉的Gensini积分,比较患者甲状腺激素水平与Gensini积分之间的关系。结果:(1)与非冠心病组相比较,冠心病组游离三碘甲状原氨酸(FT3)明显减低,差异有统计学意义(P=0.001);(2)血浆FT3水平与Gensini积分呈反比关系(r=-0.479,P0.001);(3)血浆FT3水平是冠状动脉严重病变的保护性因素(OR=0.055,95%CI:0.011~0.273,P0.001)。结论:在甲状腺功能正常的老年患者中,血浆FT3水平的降低与冠心病的发生相关,血浆FT3水平的降低预示着冠状动脉病变较严重,血浆FT3是冠状动脉病变的保护性因素,其水平的降低是冠状动脉病变严重程度的独立预测因子。     

胰岛素抵抗与血清循环内分泌因子在冠心病发病中的作用

目的　研究胰岛素抵抗与血清循环内分泌因子在冠心病发病中的作用。方法　分别测定 52例老年冠心病患者〔冠心病组 ,其中不稳定心绞痛 ( UAP组 ) 3 0例 ,急性心肌梗死 ( AMI组 ) 2 2例〕及 3 0例健康人 (对照组 )血浆 t-PA (组织型纤溶酶原激活物 )、PAI(纤溶酶原激活物抑制物 )、ET(内皮素 )、SOD(超氧化物歧化酶 )、L PO (过氧化脂质 )、Ins(胰岛素 )、C-P( C-肽 )等及血清甲状腺激素 T3、T4、r T3(反 T3)、FT3(游离 T3)、FT4(游离T4)、TSH(促甲状腺激素 )和血脂水平 ,并进行对照分析。结果　冠心病组 (尤其是 AMI组患者 ) Ins、C-P、Ins/ SG(胰岛素 /血糖 )、IAI(胰岛素敏感指数 ) PAI、ET、L PO、r T3均比对照组显著升高 ( P<0 .0 1及 P<0 .0 5) ;而 t-PA、SOD、T3、FT3、T4 比对照组降低 ( P<0 .0 1及 P<0 .0 5)。结论　老年冠心病患者存在胰岛素抵抗 ,ET增加 ;PAI升高及 t-PA降低诱发了冠脉内的粥样硬化斑块破裂或出血 ,血小板聚集及血栓形成 ,从而促发 UAP或 AMI。血清甲状腺激素的变化对了解心肌梗死患者的心肌坏死量 ,判断病情及预后有一定帮助     

Change in serum thyroid hormone levels in patients with acute myocardial infarction

It has been reported that there is a decrease in the serum concentration of thyroid hormones in non-thyroidal illness. In the present study we made serial measurements of serum concentration of thyroid hormones [triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3), free thyroxine (FT4), reverse triiodothyronine (rT3)], thyroid stimulating hormone (TSH) and thyroxine binding globulin (TBG) in 10 patients with acute myocardial infarction (AMI, Grade I, according to the classification of Killip & Forrester) during 14 days after onset. In the early phase of AMI, serum T3, T4, FT3 and FT4 levels decreased while rT3 increased. TSH and TBG levels, however, were unchanged. In the patients with a high peak creatine phosphokinase activity (greater than or equal to 400 mU/ml), the decrease in thyroid hormone and increase in serum rT3 levels were greater than in patients with a low peak value (less than 400 mU/ml), suggesting a correlation between severity of AMI and changes in serum thyroid hormone levels. Especially, serum FT3 levels fell below the lower limit of controls within 14 days, with the lowest levels and the rT3 peak on the third day after onset. These data suggest that in AMI peripheral conversion of T4 favours rT3 production and that low levels of serum FT3 and T3 protect the infarcted heart muscle against thyroid hormone action.     

心力衰竭患者甲状腺激素改变的临床意义

心力衰竭患者甲状腺激素水平可有明显改变,且心力衰竭越严重,其T3、FT3水平下降与rT3水平升高越明显,而TSH无明显变化.提示甲状腺激素变化或许可以作为判断心力衰竭严重程度的参考指标.     

Rapid down-regulation of thyroid hormones in acute myocardial infarction: is it cardioprotective in patients with angina?

BACKGROUND: In severe illness of any cause, down-regulation of the thyroid hormone system may occur. How this affects patients with acute myocardial infarction (AMI) is largely unknown. OBJECTIVE: To investigate changes in serum levels of the thyroid hormones during AMI and their association with cardiac function and outcome. METHODS: Forty-seven consecutive euthyroid patients with AMI were studied prospectively during the first 5 days and again 6 and 12 weeks later. Time from pain onset was used in all analyses. RESULTS: The thyroid hormone system was rapidly down-regulated with maximal changes 24 to 36 hours after onset of symptoms. The mean level of the hormone total triiodothyronine (T3) decreased 19% (P =.02), the inactive metabolite reverse T3 (rT3) levels increased 22% (P =.01), and thyrotropin levels declined 51% (P<.001) between the first 6-hour and the 24- to 36-hour period. The prohormone free thyroxine was largely unchanged. Patients with poor heart function or more intense inflammatory reaction showed more pronounced down-regulation of the thyroid system. No correlation was found with cardiac enzymes. Patients with prior angina pectoris had lower T(3) levels in early samples, smaller infarctions, and higher levels of C-reactive protein and the proinflammatory cytokine interleukin 6 on admittance. Peak levels of interleukin 6 correlated negatively with T3 (P =.005) and positively with rT3 (P<.05), suggesting that down-regulation before AMI may be cardioprotective. However, mortality was high among patients with the most pronounced thyroid level depression, indicating that down-regulation after AMI may be maladaptive. CONCLUSIONS: The thyroid hormone system is rapidly down-regulated in AMI. This may be beneficial during acute ischemia. Patients with angina had higher levels of interleukin 6 and C-reactive protein and more depressed thyroid hormone system in early samples. Thyroid level depression in patients with angina may possibly have been present before the infarction process started. This novel finding needs further evaluation in large studies to sort out cause-and-effect relationships.     

甲状腺素在急性心肌梗死中变化特点及短期预后价值

目的探讨急性心肌梗死患者中甲状腺激素水平变化特点及原因,并分析其对短期死亡终点预后价值。方法入选172例急性心肌梗死患者,并选取92例不稳定型心绞痛患者为对照组。所有入选患者均于入院后第2天测定游离三碘甲腺原氨酸（FT4）、血清游离甲状腺素（FT4）、促甲状腺激素（TSH）水平,测定血脂水平及高敏C反应蛋白水平。同时观测住院期间心血管死亡事件。结果急性心肌梗死患者中,FT3、FT4、TSH水平分别为（2．33±0．47）ng／L,（12．5±2．4）ng／L和（1．32±0．99）μU／L。不稳定型心绞痛患者中,FT3、FT4、TSH水平分别为（2．80±0．54）ng／L,（11．5±1．4）ng／L和（2．19±1．07）μ／L。急性心肌梗死患者中FT3和TSH水平较不稳定型心绞痛患者明显降低（P〈0．05）,而FT4水平在两组中差异无统计学意义（P〉O．05）。同时,急性心肌梗死患者中总胆固醇、低密度脂蛋白胆固醇和高敏C反应蛋白水平较不稳定型心绞痛患者明显升高（P〈0．05,P〈0．01）。FT3水平与年龄、总胆固醇及高敏C反应蛋白水平呈线性相关,应用ROC曲线分析FL水平对住院期间心血管事件死亡率预测价值,ROC曲线下面积为0．852,具有较好的预测价值。分别分析ST段抬高型和非ST段抬高型心肌梗死患者中甲状腺激素及血脂水平,两组间差异无统计学意义（P〉0．05）。结论急性心肌梗死患者中FT3,TSH水平下降,FT3水平的变化对住院期间心血管事件死亡率具有较好预测价值。     

急性心肌梗死患者甲状腺激素水平与冠状动脉病变严重程度相关性研究

目的:探讨急性心肌梗死患者甲状腺激素水平与冠状动脉病变严重程度及心脏功能的关系。方法:选取甲状腺功能正常的急性心肌梗死患者341例,检测促甲状腺激素(TSH)水平,游离三碘甲状腺原氨酸(FT3),游离四碘甲状腺原氨酸(FT4),血脂水平,高敏C反应蛋白,统计住院期间严重心血管事件率(严重心律失常、心源性休克、急性左心功能衰竭及死亡)。超声心动图检查左心室射血分数,左心室舒张功能。根据FT3三分位分为FT3 1.16～2.25 pg/ml组113例、FT3 2.26～2.81 pg/ml组114例、FT3 2.82～4.02 pg/ml组114例。224例行冠状动脉造影评估冠状动脉病变严重程度患者,根据病变血管支数分为单支病变患者70例和多支(≥2支)病变患者154例。结果:FT3 2.82～4.02 pg/ml组与FT3 1.16～2.25 pg/ml组比高敏C反应蛋白明显下降、左心室舒张功能指标E/A(左心室舒张早期二尖瓣口血液流速/左心室舒张末期流速)值增高、严重心血管事件率下降,差异有统计学意义(P<0.05或0.01)。多支病变患者TSH、FT4、FT3均较单支病变患者降低,但只有FT3差异有统计学意义(P<0.05)。Logis-tic多元回归分析显示,在校正了年龄、性别、吸烟史及高血压史、糖尿病史、血脂水平、高敏C反应蛋白水平后,FT3下降仍是冠状动脉多支病变独立危险因素(风险比为0.65,P<0.05)。结论:甲状腺功能正常的急性心肌梗死患者FT3水平与心脏舒张功能、严重心血管事件率及冠状动脉病变严重程度密切相关,FT3可作为反映心肌梗死患者病情的一项重要指标。     

Thyroid hormone concentrations, disease, physical function, and mortality in elderly men

CONTEXT: Physiological changes in thyroid hormone concentrations might be related to changes in the overall physical function in the elderly. OBJECTIVE: We determined to what extent thyroid hormone concentrations are related to physical function and mortality in elderly men. DESIGN: A longitudinal population study (the Zoetermeer study) was conducted. Mortality was registered in the subsequent 4 yr. PARTICIPANTS: Four hundred three independently and ambulatory living men (aged 73-94 yr) participated. MAIN OUTCOME MEASURES: The study examined the association between serum thyroid hormones and parameters of physical function as well as the association with mortality. METHODS: TSH, free T4 (FT4) total T4, T3, rT3, and T4-binding globulin were measured. Physical function was estimated by the number of problems in activities of daily living, a measure of physical performance score (PPS), leg extensor strength and grip strength, bone density, and body composition. RESULTS: Serum rT3 increased significantly with age and the presence of disease. Sixty-three men met the biochemical criteria for the low T3 syndrome (decreased serum T3 and increased serum rT3). This was associated with a lower PPS, independent of disease. Furthermore, higher serum FT4 (within the normal range of healthy adults) and rT3 (above the normal range of healthy adults) were related with a lower grip strength and PPS, independent of age and disease. Isolated low T3 was associated with a better PPS and a higher lean body mass. Low FT4 was related to a decreased risk of 4-yr mortality. CONCLUSIONS: In a population of independently living elderly men, higher FT4 and rT3 concentrations are associated with a lower physical function. High serum rT3 may result from a decreased peripheral metabolism of thyroid hormones due to the aging process itself and/or disease and may reflect a catabolic state. Low serum FT4 is associated with a better 4-yr survival; this may reflect an adaptive mechanism to prevent excessive catabolism.     

THYROID HORMONES AND THE REGULATION OF THYROID FUNCTION IN MEN WITH COELIAC DISEASE

A specific pattern of thyroid hormone abnormalities was observed in twenty-seven men with coeliac disease which differed from that observed in patients with non-thyroidal illness (NTI). Serum free thyroxine (FT4) was reduced, but increased after gluten was withdrawn from the diet and jejunal morphology improved. Total T4 (TT4), total triodothyronine (TT3), free triiodothyronine (FT3) and reverse T3 (rT3) levels were unchanged, unlike the findings in nineteen men with Crohn's disease when TT3 fell, rT3 tended to rise but TT4, FT4 and FT3 levels were normal, except FT4 was significantly higher in a subgroup of patients who were more severely ill. The thyroid hormone changes in Crohn's disease are those expected in NTI. Basal serum thyrotrophin (TSH) was normal in all but one of the patients with coeliac disease but 45% of untreated coeliacs had exaggerated responses of TSH to thyrotrophin releasing hormone, an observation which cannot be explained as a feature of NTI. These changes in thyroid hormones in coeliac disease could not be attributed to abnormalities of thyroxine-binding globulin or thyroxine-binding prealbumin, and thyroid autoantibodies were not detected in these patients. Hence, different patterns of thyroid hormone abnormalities can occur in different diseases of the same organ in patients of equivalent nutritional status. Circulating gluten peptides may be involved in the hypothalamic-pituitary disturbance of coeliac disease.     

老年人血管性痴呆与甲状腺轴功能关系的研究

目的　探讨老年人血管性痴呆（VD）与甲状腺轴功能的关系。　方法　采用放射免疫分析法检测31例VD患者、22例不伴有痴呆的脑血管病（CVD）患者及22例同龄对照的血清三碘甲状腺原氨酸（T     

AECOPD患者甲状腺激素水平变化及临床意义

目的观察慢性阻塞性肺疾病急性加重期（AECOPD）患者甲状腺激素水平的变化,探讨其临床意义。方法采用化学发光法测定102例AECOPD患者血清总三碘甲状腺原氨酸（TT3）、总甲状腺素（TT4）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺素（TSH）水平,并与84例健康体检者进行对照。结果 AECOPD血清TT3、TT4、FT3与对照组比较差异有统计学意义（P〈0.01）;好转组与死亡组AECOPD患者血清TT3、FT3比较差异有统计学意义（P〈0.05或P〈0.01）;无呼吸衰竭组与Ⅰ型呼衰组、Ⅱ型呼衰组患者血清TT3、FT3比较差异有统计学意义（P〈0.01）。结论血清甲状腺激素水平变化反映AECOPD患者病情严重程度,可用于AECOPD患者病情的评估。