参麦注射液治疗充血性心力衰竭及对甲状腺激素影响的研究

目的观察参麦注射液治疗充血性心力衰竭(CHF)的疗效及对甲状腺激素的影响.方法将70例病人分为两组,两组均以西医常规治疗,治疗组加用参麦注射液治疗,疗程为2周,治疗前后采用放射免疫法检测三碘甲状腺原氨酸(T3)、甲状腺素(T4)、反三碘甲状腺原氨酸(rT3)及促甲状腺素(TSH)指标.结果治疗组总有效率较对照组高;经2周治疗后,治疗组和对照组T3、T4由治疗前较低水平显著升高,rT3由治疗前的较高水平显著降低(P＜0.05).而治疗组治疗后这3项指标与对照组比较均有统计学意义(P＜0.05).结论参麦注射液可纠正CHF病人异常的甲状腺激素.     

甲状腺素在充血性心力衰竭中的应用

近年来,充血性心力衰竭(CHF)时甲状腺激素(TH)的异常,日益受到关注,主要表现为三碘甲状腺原氨酸(T_3)降低,四碘甲状腺原氨酸(T_4)降低或正常,反三碘甲状腺原氨酸(γ_T_3)明显升高。促甲状腺激素(TSH)正常。而临床上并没有甲状腺功能减退表现,本文将阐述甲状腺激素在充血性心力衰竭时的应用。1 CHF 时甲状腺激素变化的意义和机理为了研究 CHF 时甲状腺激素的变化,多数学者对 CHF 患者设置对照组进行研究,均发现 CHF 治疗前几乎所有患者 T_3下降,γ_T_3升高,T_3/γ_T_3 下降,TSH正常,约50%患者 T_4正常。并提示随着心功能不全加     

充血性心力衰竭患者甲状腺激素变化的临床意义

为探讨充血性心力衰竭（CHF）患者甲状腺激素异常变化的临床意义，对33例CHF及15例正常人血清甲状腺激素水平进行测定。结果表明：CHF组三碘甲状腺原氨酸（T3）、反三碘甲状腺原氨酸（rT3）与对照组比较有显著差异（P＜0．05），CHF组随着病情加重，T3逐渐降低，rT3逐渐增高；总甲状腺素及促甲状腺激素无明显改变。血清T3及rT3的改变可作为判断CHF严重程度的指标。     

心衰患者TNF-α、生长激素与下丘脑-垂体-甲状腺轴的相关性

目的:研究充血性心衰(CHF)患者肿瘤坏死因子、生长激索与下丘脑-垂体-甲状腺轴(HHTA)的关系。方法:应用放免法测定28例CHF患者及14例健康人的血清肿瘤坏死因子-α(TNF-α),生长激素(GH)及甲状腺激素的含量。后者包括三碘甲状腺原氨酸(T3),四碘甲状腺原氨酸(T4),游离T3(FT3).游离T4(FT4)及反T3(rT3)。还测定了促甲状腺激素(TSH),促甲状腺激素释放激素(TRH)的含量。结果:①CHF患者血清TNF-α,GH,T3,FT3,FT4,rT3浓度与对照组相比发生显著性变化,而TSH、TRH无显著变化;②血清TNF-α与FT3呈显著负相关(r=-0.54.P<0.05);③血清GH与HHTA系统呈显著负相关(r=-0.57)。结论:①在CHF患者,HHTA系统调节失衡;②TNF-α,GH与HHTA系统间相互影响,可能加速心功能恶化。     

老年慢性心力衰竭病人甲状腺激素水平的变化及意义

目的探讨老年慢性心力衰竭（CHF）病人甲状腺激素水平的变化及临床意义。方法采用时间分辨荧光免疫分析法，测定68例老年CHF病人抗心力衰竭治疗前后的血浆游离三碘甲状腺原氨酸（FT3）、游离甲状腺激素（FT4）、总三碘甲状腺原氨酸（TT3）、总甲状腺素（TT4）、促甲状腺表（TSH）水平，并与30名健康者对照分析。结果老年CHF组TT3、FT3较对照组下降（P＜0.05或P〈0.01），且CHF组随着心力衰竭的加重，TT3、FT3水平逐渐减低；TT4、FT4、TSH CHF各组与对照组比较无统计学意义（P〉0．05）；抗心为衰竭治疗后TT3、FT3水平明显上升（P〈0．05或P〈0.01）。结论老年CHF病人常伴有正常甲状腺痛态综合征。甲状腺激素水平的变化，可评估老年CHF病人的严重程度、治疗效果及预后。     

老年慢性心力衰竭患者的正常甲状腺功能病态综合征

目的　探讨老年慢性心力衰竭患者中正常甲状腺功能病态综合征的情况及其与老年人病情和预后的关系。方法　运用化学发光免疫法测定老年慢性心力衰竭患者 (6 6例 )及对照组 (30例 )血浆三碘甲状腺原氨酸 (T3 )、甲状腺素 (T4)、游离三碘甲状腺原氨酸 (FT3 )、游离甲状腺素 (FT4)及促甲状腺素 (TSH)水平。结果　心力衰竭患者与对照组比较 ,T3 、FT3 明显降低 ,心力衰竭越重 ,降低越明显。心功能分级标准Ⅳ级患者T4、FT4及TSH较对照组降低明显 ,T4、FT4降低或合并TSH降低者 ,病死率高。结论　老年慢性心力衰竭患者常伴有正常甲状腺功能病态综合征 ,尤其是正常甲状腺功能病态综合征中低T3 低T4综合征为预后不良指标。甲状腺激素有望成为心力衰竭治疗中的一类新型药物。     

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。     

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.     

甲状腺激素治疗充血性心力衰竭的观察

目的　评价甲状腺激素 ( TH)治疗充血性心力衰竭 ( CHF)的疗效。方法　 5 5例 CHF病人随机分为治疗组和对照组 ,治疗组在对照组常规治疗 CHF的基础上加用小剂量 TH,疗程 4周 ,测定治疗前后 TH水平和 CHF患者心功能变化情况。结果　 CHF患者三碘甲腺原氨酸 ( T3 )、四碘甲腺原氨酸 ( T4)明显降低 ,且与心力衰竭程度成正比 ,反三碘甲腺原氨酸 ( r T3 )升高 ,经小剂量 TH治疗后 T3 、T4升高 ,r T3 降低 ,心功能明显改善。结论　 CHF病人存在低 TH状态 ,经 TH治疗后心功能明显改善 ,自觉症状好转。     

甲状腺激素水平与充血性心力衰竭的相关性以及小剂量甲状腺素的干预作用

目的:探讨甲状腺激素水平与充血性心力衰竭(CHF)的相关性,观察小剂量甲状腺素治疗CHF的效果。方法:采用放射免疫法测定68例充血性心力衰竭患者(CHF组)及50例健康对照者(对照组)的血清三碘甲腺原氨酸(T3)、游离三碘甲腺原氨酸(FT3)、甲状腺素(T4)、游离甲状腺素(FT4)和促甲状腺激素(TSH)水平,并进行比较。然后将甲状腺素水平降低的52例CHF患者分为观察组和治疗组,分别给予常规抗心衰治疗和常规抗心衰治疗+小剂量甲状腺素治疗,比较两组患者治疗前后心功能变化情况。结果:CHF组与对照组相比,T3、FT3水平明显降低(P0.05),且心力衰竭程度越重,T3、FT3水平降低越明显(P0.05),T4、FT4、TSH水平无显著性差异(P0.05)。CHF治疗组心功能改善明显优于CHF观察组(P0.05)。结论:CHF患者常伴有血清甲状腺素水平下降,且甲状腺素水平降低与心衰程度密切相关。短程小剂量甲状腺素治疗CHF安全、有效。     

Early manifestations of "sick euthyroid" syndrome in patients with compensated chronic heart failure.

BACKGROUND: A "sick euthyroid" syndrome occurs in patients with severe decompensated chronic heart failure (CHF) and other chronic illnesses and is related to adverse prognosis, but it has not been described in patients with compensated CHF. The aim of this study was to determine whether manifestations of the sick euthyroid syndrome occur in patients with compensated CHF caused by ischemic heart disease. METHODS AND RESULTS: Thyroid hormonal responses to thyrotropin-releasing hormone (TRH) stimulation were compared in 8 patients with New York Heart Association class I/II CHF considered secondary to ischemic heart disease and 7 control patients after serial 10-minute blood sampling over 3-hour periods. Secretory dynamics of TRH-induced thyroid-stimulating hormone (TSH) release were compared by using deconvolution analysis. Changes in serum thyroxine (T4), triiodothyronine (T3), reverse T3 (rT3), and rT3/T4 concentration ratios were compared. Patients with CHF had lower baseline serum T3 concentrations (P <.001), with lower maximum serum T(3) (P <.01) and higher maximum serum rT(3) (P <.05) concentrations after TRH stimulation but similar estimated TRH-induced TSH secretory burst amplitude, mass, and 3-hour production rates, compared with control patients. CONCLUSIONS: Patients with compensated CHF display the derangements in thyroid hormone metabolism of impaired peripheral conversion of T4 and T3 and increased production of rT(3) in the presence of normal dynamic function of the hypothalamic-pituitary-thyroid axis, which are consistent with early manifestations of a sick euthyroid state.     

老年人充血性心力衰竭短期加用小剂量甲状腺素治疗的临床观察

目的　探讨小剂量甲状腺素在老年充血性心力衰竭 (CHF)中的临床疗效。方法　选择 15 6例CHF病人 ,测定血清甲状腺素及超声心动图 (EF ,CO ,PWtf)后分成治疗组和对照组。治疗组在常规治疗基础上加用左旋甲状腺素(L T4) 2 5～ 5 0 μg/d ;对照组仅给常规治疗于病人住院 7d、14d通过评价心功能 ,进行疗效评价。结果　两组病人T3 降低、rT3 明显升高 ,T4、hTSH正常。第 7d ,治疗组有效率较对照组提高 ,但两组比较无统计学意义 (P >0 0 5 ) ;第 14d ,治疗组总有效率 76 19% ,明显高于对照组 (5 8 33% ) (P <0 0 5 ) ;EF、CO、PWtf治疗组均优于对照组 (P <0 0 5 )。结论　对老年重度心力衰竭病人在应用利尿剂、血管紧张素转换酶抑制剂的基础上 ,加用小剂量L T4,对部分老年重症CHF的治疗可能有一定的短期、辅助意义。     

Ethanol feeding and thyroid hormone monodeiodination

Adult male rats were placed on a 3 week regimen of ethanol (as 20% of total calories) in a nutritionally adequate diet, and controls were matched equicalorically without ethanol. Serum measurements of T4, T3, FT4, rT3, and TSH were performed in both the fed and the fasted state (18 hours). In the fed state, serum hormone measurements did not differ between control and ethanol-treated rats. Overnight fasting had a significant effect in decreasing serum T3 level in both experimental and control rats and in decreasing serum T4 level in ethanol-treated animals; FT4 and rT3 levels were not affected. Fasting also decreased in vitro hepatic T4 to T3 production to an equivalent degree in control and ethanol-treated rats, but did not alter hepatic T4 to rT3 production rates in control animals. In the fed state, hepatic rT3 neogenesis in animals given ethanol declined relative to the levels observed in control fed rats; fasting restored the depressed rT3 neogenesis to the levels noted in the fed state. Because decreased rT3 production in ethanol-treated rats in the fed state could not be explained on the basis of a change in 5'-deiodinase activity, it is suggested that ethanol administered with a nutritionally adequate diet may inhibit hepatic rT3 generation by inhibiting T4(5)-deiodinase.     

AlphaANP, AVP, and pituitary-thyroid axis in patients with congestive heart failure and acute respiratory failure

The pituitary-thyroid axis and neurohumoral activation indexes were simultaneously investigated in 16 in-patients hospitalized for cardiac heart failure (CHF), New York Heart Association (NYHA), class II-IV, and Killip clinical scale, class II-III, to evaluate their relationship with CHF morbidity and the relative prognostic value. At entry the patients were divided into two subgroups (A and B), according to the severity of CHF. Patients were further classified into two subgroups, according to the subsequent clinical course (C, poor outcome and D, improved clinical course). Blood samples were obtained every day for the radioimmunoassay measurement of plasma alpha-atrial natriuretic peptide (alphaANP), arginine vasopressin (AVP), and thyroid hormones, and the results were compared with those of 12 control subjects. At admission, alphaANP and 3,3',5'-triiodothyronine (rT3) values were higher, while 3,3',5-triiodothyronine (T3) to rT3 (T3/rT3) ratio was lower in subgroups A and B than in controls (p<0.001), respectively, and in C than in D (p<0.001), respectively, according to the prognosis. Conversely, no differences in other thyroid indexes, nor a significant correlation between alphaANP and either rT3 or T3/rT3 ratio were present in any of the subgroups. AVP plasma levels in subgroup A were not statistically different from those of controls, whereas they were significantly decreased in subgroups B and C (p<0.05) and D (p<0.001). In conclusion, these results indicate that in CHF the pituitary-thyroid axis is not altered, that alphaANP and T3/rT3 ratio are non-invasive and reliable predictors of severity and prognosis, while AVP might be affected by the different pathological processes leading to CHF or by the concomitant use of drugs.     

肝功能异常水平对慢性心力衰竭患者的预测价值

目的探讨慢性心力衰竭(chronic heart failure,CHF)患者肝功能损害水平与CHF严重程度之间的关系。方法87例CHF住院患者根据纽约心功能分级分为心功能Ⅱ级23例,心功能Ⅲ～Ⅳ级64例。CHF患者入院第2天行肝功能、脑钠肽(brain natriuretic peptide,BNP)及超声心动图检查。同期,选取30例排除心力衰竭的门诊体检者行肝功能及超声心动图检查。结果CHF组血清丙氨酸氨基转移酶(Alt)、天门冬氨酸氨基转移酶(Ast)和总胆红素均显著高于对照组,差异有统计学意义(P<0.05)。心功能Ⅲ～Ⅳ级组丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素和BNP均显著高于心功能Ⅱ级组,差异有统计学意义(P<0.05)。CHF组白蛋白和左心室射血分数低于对照组,心功能Ⅲ～Ⅳ级组白蛋白和左心室射血分数低于心功能Ⅱ级组,差异均有统计学意义(P<0.05)。心功能Ⅲ～Ⅳ级组直接胆红素水平高于对照组,差异有统计学意义(P<0.05)。CHF组丙氨酸氨基转移酶、天门冬氨酸氨基转移酶、总胆红素、直接胆红素与BNP成正相关(r1=0.37,r2=0.434,r3=0.49,r4=0.406,P<0.01);丙氨酸氨基转移酶、总胆红素和BNP与左心室射血分数成负相关(r1=-0.303,r2=-0.426,r3=-0.455,P<0.01)。结论CHF患者常出现肝功能及BNP水平改变,其水平高低对于判断心力衰竭的严重程度有一定的预测意义。     

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.     

慢性心力衰竭患者血清CA125水平检测及临床意义

目的 研究慢性心力衰竭(CHF)患者不同心功能状态下血清肿瘤抗原125(CA125)水平的改变及其临床意义.方法 对32例CHF患者按照纽约心功能分级标准分为心功能Ⅰ级和Ⅱ级组(A组)17例心功能Ⅲ级和Ⅳ级组(B组)15例,用化学发光法测定其血清CA125水平,并与25例健康人比较.结果 CHF患者血清CA125平均水平高于对照组(P<0.01),B组血清CA125平均水平高于A组.结论 血清CA125水平与CHF患者心功能相关,临床上观察CA125的水平变化可以作为评价CHF患者心功能的一个重要指标.     

慢性心力衰竭患者血清三碘甲状腺原氨酸水平与脑利钠肽关系探讨

目的探讨慢性心力衰竭（CHF）患者血清三碘甲状腺原氨酸（T3）水平与脑利钠肽（BNP）的关系。方法测定114例慢性心力衰竭患者测定血清T3和BNP浓度。其中伴低T3血症的慢性心力衰竭患者60例（低T3组）和正常血T3的慢性心衰患者54例（正常T3组），观察两组BNP水平及6月内的再住院率。结果低T3组的心衰患者血清BNP水平均较正常T3组相同心功能级别者显著升高。低血T3组与正常血T3组心功能Ⅱ级、Ⅲ级、Ⅳ级的比较，BNP（pg/ml）分别为：280．4±80．2vs150±55．6，380±113．2vs300±63．5，570±133．3VS450．2±100．9，P〈0．01，低T3组再住院率高。结论慢性心衰伴低T3患者，血清BNP升高更明显，再住院率高。     

PROPRANOLOL VERSUS CARBIMAZOLE AS THE SOLE TREATMENT FOR THYROTOXICOSIS. A CONSIDERATION OF CIRCULATING THYROID HORMONE LEVELS AND TISSUE THYROID FUNCTION

Serum triiodothyronine (T3), thyroxine (T4) and reverse triiodothyronine (rT3) levels were measured in seven hyperthyroid patients during 2 months of propranolol therapy and subsequently during 2 months of carbimazole. In keeping with previous observations, there was a slight fall in serum T3 level accompanied by elevations of serum T4 and rT3 during propranolol. As a consequence of carbimazole treatment, serum T3 and T4 fell markedly and rT3 was undetectable. Three parameters of tissue thyroid function, glucagon stimulated cyclic AMP levels, systolic time intervals (STI) and visual evoked response (VER) were monitored in parallel to the peripheral hormone changes. There was no real improvement in tissue function during propranolol treatment. During carbimazole administration there was significant improvement in STI and VER as compared to pre-treatment values, and a significant improvement in glucagon stimulated cyclic AMP levels as compared to the levels attained after 2 months of propranolol therapy. Thus, the small fall in serum T3 produced by propranolol does not result in improved tissue thyroid function in thyrotoxicosis, whereas carbimazole brings about a dramatic improvement in peripheral hormone levels, and tissue function alike. Moreover, propranolol therapy can be hazardous in thyrotoxicosis, two patients with no previous history of heart disease developing left ventricular failure soon after its commencement.     

慢性充血性心衰者血清生长激素与肿瘤坏死因子水平变化及意义

目的：研究慢性充血性心力衰竭（CHF）患者血清生长激素（GH）及肿瘤坏死因子α（TNF-α）的含量变化及意义。方法：应用放射免疫法测定36例CHF患者及30例健康体检者的血清GH及TNF-α含量,并比较两组的含量。结果：与健康体检者比较,CHF患者血清GH[（1.91±0.67）ng/ml∶（4.87±1.64）ng/ml]、TNF-α[（19.23±6.78）fmol/ml∶（44.64±19.48）fmol/ml]浓度显著升高（P〈0.01）;TNF-α水平随心功能分级增高而增高,心衰各组间差异显著（P〈0.05~0.01）。结论：结果提示血清生长激素和肿瘤坏死因子α均与心衰的发生和发展有关,肿瘤坏死因子α与心功能状态有关。