原发性甲状腺功能减退症致心肌酶谱显著增高16例

甲状腺功能减退症 (甲减 )是由于各种原因造成甲状腺激素缺乏引起的一系列临床表现。中重度甲减血清心肌酶谱均可升高 〔1〕,但心肌酶显著升高临床罕见。收集我院 1992年 3月至2 0 0 0年 11月甲减 16例 ,旨在探讨甲减与心肌酶谱显著升高的关系 ,为临床及时诊治提供依据。1　临床资料1.1　一般资料　 16例中男 6例 ,女 10例 ,年龄 6 0～ 72岁。 15～ 2 0年前疑诊为“桥本甲状腺炎”8例 (男 2例 ,女 6例 )。 15～2 0年前因“甲亢”行甲状腺部分切除术后引起的甲减 4例 (男 2例 ,女 2例 ) ,13～ 2 0岁前因“甲亢”行 1 31 治疗引起甲减 4例(男…     

原发性甲减患者甲状腺功能与心肌酶谱的相关性研究

为探讨原发性甲状腺功能减退症(甲减)患者甲状腺功能与心肌酶谱的关系，检测了18例原发性甲减患者和18例查体健康者(对照组)的空腹血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、高敏促甲状腺(sTSH)、肌酸激酶(CK)及其同工酶CK—MB、乳酸脱氢酶(LDH)及其同工酶HBDH、天门冬酸氨基转移酶(AST)、总胆固醇(Tch)。结果显示，原发性甲减患者AST、CK、CK—MB、LDH、HBDH及Tch均明显高于对照组(P分别＜0．001、0．001、0．05、0．005、0．005、0．005)；sTSH和FT4与心肌诸酶、Tch均无相关性；FT3与CK—MB呈负相关(r＝-0．53，P＜0．05)，与Tch呈负相关(r＝-0．528，P＜0．05)。提示原发性甲减患者常伴心肌诸酶及Tch升高，其FT3水平下降与CK—MB、Tch升高关系更密切。     

左旋甲状腺素钠对老年甲状腺功能减退患者炎性因子、心肌酶谱及甲状腺功能的影响

目的探讨左旋甲状腺素钠对老年甲状腺功能减退患者炎性因子、心肌酶谱及甲状腺功能的影响。方法选择62例老年原发性甲状腺功能减退症(甲减)患者为研究对象,采用随机对照方法分为观察组32例和对照组31例。观察组给予左旋甲状腺素钠替代治疗,对照组给予甲状腺片治疗。两组均连续治疗6个月,比较血清炎性因子、心肌酶谱、甲状腺功能、临床疗效等指标。结果观察组有效率(96.86%)明显高于对照组(80.00%)(χ2=4.402,P0.05);血清肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、高敏C反应蛋白(hs-CRP)含量明显低于对照组(t=3.024、2.480、5.353,均P0.05);血清天冬氨酸氨基转移酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)含量均明显低于对照组(t=11.776、5.987、13.210、4.204,均P0.05);血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、总甲状腺素(TT4)明显高于对照组,促甲状腺素(TSH)明显低于对照组(t=6.733、2.935、2.674、11.350,均P0.05)。结论左旋甲状腺素钠有助于减轻老年甲减患者炎性反应,改善心肌酶紊乱,促进甲状腺功能恢复,提高临床疗效。     

心肌酶异常升高的原发性甲状腺功能减退症一例

患者 ,男性 ,73岁。因间断头晕、头疼 2 0年 ,胸闷 5年加重1个月入院。自诉 2 0余年出现间断头疼、头晕 ,多次住院诊断为高血压病 ,间断服用降压药 ,未监测血压。近 5年症状反复时伴胸闷、气短 ,活动耐力下降 ,双下肢浮肿 ,诊断为高血压性心脏病 ,持续性房颤 ,心力衰竭 (心衰 ) ,曾予对症治疗 ,症状可改善。就诊前 1个月来无诱因出现乏力 ,胸闷 ,气短 ,双下肢、眼睑浮肿 ,活动耐力下降 ,少尿 ,纳差 ,腹胀 ,头晕 ,喜睡 ,自已服用开博通、鲁南欣康、速尿 ,症状仍进行性加重。入院检查 :T3 6.5℃ ,P 5 6次 /分钟 ,R 2 0次 /分钟 ,BP 15 0 /90…     

原发性甲状腺功能减退症致心肌酶谱显著增高12例治疗转归

收集我院１９９１年１０月至１９９８年１０月甲状腺功能减退症（甲减）中致心肌酶谱显著增高１２例,现就其临床表现、甲状腺功能、心肌酶谱、心脏Ｂ型超声检查及血脂等改变及治疗作一探讨。一、临床资料１．一般资料：１２例病人中,男４例,女８例,年龄（５８．５±１１．６）岁（４９～７０岁）。１６～２２年前疑诊为“桥本甲状腺炎”７例,男１例,女６例,其中２例做过病理检查而确诊。１４～２０年前因“甲亢”行１３１碘治疗后引起甲减３例,男１例,女２例。１５～２３年前因“甲亢”行甲状腺部分切除术后引起甲减的２例,均为男…     

甲状腺素对原发性甲减患者心肌酶谱、血脂的影响

原发性甲状腺功能减退症(甲减)是由于各种原因造成甲状腺合成、分泌甲状腺激素缺乏,机体的代谢和身体的各个系统功能减退,而引起的临床综合征.近年来陆续有原发性甲减患者心肌酶谱增高的个案报道~([1,2]),亦有研究~([3])显示甲减时血总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平增高,但对原发性甲减患者心肌酶谱、血脂水平的升高及甲状腺素治疗后对其动态影响缺乏系统性的研究资料.     

甲状腺功能减退症患者的左甲状腺素钠替代治疗剂量研究

目的探讨甲状腺功能减退症患者左甲状腺素钠替代治疗的合适剂量。方法甲状腺功能减退症患者1 368例,按照入选患者首次确诊时甲状腺激素测定结果进行分组:A组:单纯TSH升高(亚临床甲减);B组:TSH升高伴T4和(或)FT4降低;C组:TSH升高伴T3和(或)FT3降低;D组:TSH升高伴T4、T3、FT3、FT4降低。分析各组左甲状腺素钠替代治疗的剂量差别。结果 A、B、C、D组左甲状腺素钠替代治疗的合适剂量分别为(38±8.5)、(62±9.2)、(88±7.9)、(114±9.4)μg,各组间比较P均<0.05。结论对于甲状腺功能减退症患者可以根据治疗前的甲状腺激素测定结果,大致推断替代治疗的合适剂量,从小剂量开始逐渐增加剂量直到合适剂量,维持6周以上再测定甲状腺激素水平,从而减少甲状腺激素测定的次数,并能够使甲状腺功能减退症患者的甲状腺功能尽快恢复正常。     

原发性甲减患者左旋甲状腺素治疗后血脂、心肌酶谱及体成分的变化

目的观察原发性甲减患者在左旋甲状腺素治疗后血脂、心肌酶谱及体成分的改变.方法原发性甲减患者58例,在诊断初和经左旋甲状腺素治疗2个月时分别测定空腹血清FT3、FT4、sTSH、总胆固醇(TC)、甘油三酯(TG)、门冬氨酸氨基转移酶(AST)、肌酸激酶(CK)及其同工酶CKMB、乳酸脱氢酶(LDH)及其同工酶HBDH,同时测定其体成分,包括体重(W)、体重指数(BMI)、脂肪含量百分比(FAT%)、基础代谢率(BMR)、脂肪含量(FM)、非脂肪量(FFM)以及全身水量(TBW).结果治疗前,TC水平与FT3、FT4及sTSH水平显著相关,而TG水平却未表现出与甲状腺功能有相关性.同时,FT4水平与所有心肌酶均呈负相关,而FT3和sTSH水平却仅与CK、LDH和 HBDH水平呈轻度相关.治疗后,患者甲状腺功能均恢复至正常范围,血清TC水平下降25.9%(P＜0.01),TG则下降11.6%(P＞0.05).血清CK、CKMB、LDH以及HBDH平均下降幅度则分别为54.5%、10.8%、12.3%和8.5%(均P＜0.05).治疗前后患者的体成分测定显示,W、FM、BMR、BMI以及 FAT%分别下降(1.7±3.9)kg、(2.4±3.5)kg、(64.3±140.2)kJ、(0.7±1.5)kg/m2和(3.0±3.5)%(均P＜0.05),而FFM和TBW则无明显变化.BMI减少的绝对值与FT3、FT4和sTSH的变化幅度均呈显著正相关.与体重的减少相比,FM的减少要更为显著.结论原发性甲减患者以左旋甲状腺素治疗可显著降低心肌诸酶与胆固醇水平,而对甘油三酯无明显影响.左旋甲状腺素造成的体重下降主要以脂肪含量减少为主,可能是通过增加BMR/FM比值达到减轻体重效应.     

左甲状腺素钠治疗老年甲状腺功能减退症的疗效及安全性

目的探讨左甲状腺素钠治疗老年甲状腺功能衰退症的疗效安全。方法甲状腺功能减退症患者138例,随机分为两组,每组69例,观察组采用左甲状腺素钠进行治疗,对照组采用口服甲状腺片进行治疗。观察两组治疗效果及不良反应发生率。结果观察组治愈率和总有效率都明显优于对照组(P0.05)。与治疗前比较,观察组治疗后,促甲状腺素(TSH)水平有明显下降,而游离三碘甲状腺原氨酸(FT3)和游离甲状腺素(FT4)水平则有明显提高(P0.05)。治疗后,观察组的甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)均明显下降(P0.05),且观察组TG、TC、LDL-C水平明显低于对照组(P0.05)。观察组不良反应发生率(14.50%)明显低于对照组(P0.05)。结论左甲状腺素钠是能够有效改善老年甲状腺功能衰退症,患者脂代谢,其临床应用效果明显,相比甲状腺素片更加具有安全性。     

亚临床甲状腺功能减退症的治疗

亚临床甲状腺功能减退症(亚甲减)以基线促甲状腺激素(TSH)水平升高和血清游离甲状腺素水平正常为特征，亚临床或隐匿性甲减常常反映甲状腺激素分泌的缺陷。甲状腺破坏性治疗(甲状腺次全切除术或放射碘治疗)或颈部广泛放射治疗后的亚临床甲减应开始使用左甲状腺素(L-T4)治疗；妊娠和哺乳期的亚甲减也应使用L-T4治疗。其他早期使用甲状腺激素替代治疗的指征包括TSH水平升高以及抗甲状腺过氧化物酶(TPO)抗体阳性，因为这些患者的亚甲减很可能进展为临床甲减。提示存在甲状腺激素相对缺乏的I临床体征和症状的所有患者都应该试用L-T4替代治疗，这些患者包括亚临床甲减并发不孕、抑郁症或其他神经心理异常。单纯血清TSH水平升高或高胆固醇血症不是L-T4治疗的适应症，除非患者有甲状腺疾病史以及提示甲状腺激素缺乏的临床症状。     

激光心肌血运重建术围术期心肌酶学和心电图的变化

目的　了解激光心肌血运重建术 (TMLR)围术期心肌酶及心电图的变化规律和影响因素 ,评价TMLR对心肌损伤程度 ,以利防治术后早期相关并发症。方法　采用速率法测定 5 0例TMLR患者围术期心肌酶变化 ,并行标准导联心电图。结果　TMLR后 8小时心肌酶明显升高 (P <0 0 1) ,血清肌酸激酶同工酶 (CK MB) 2 4小时达峰值 (40± 2 4)IU L ,72小时恢复。 41例 (82 % )心电图部分导联出现新的ST T改变。CK MB峰值与打孔数目及激光能量无相关性 (P >0 0 5 )。心电图存在ST段升高组心肌酶与总样本比较差异无显著性 (P >0 0 5 )。结论　TMLR术后早期心肌酶学及心电图呈现一过性心肌损伤改变 ,其改变程度与打孔数目及激光能量无显著相关性 ,术后 72小时动态监测心肌酶及心电图变化有利于早期诊治围术期严重心肌损伤或急性心肌梗塞等并发症     

Rheumatic manifestations in primary hypothyroidism

BackgroundPrimary hypothyroidism is one of the major endocrine diseases involving various organs including the musculoskeletal system leading to increased morbidity.ObjectiveTo observe the different rheumatic manifestations in patients suffering from primary hypothyroidism.Patients and methodsA total of 120 patients suffering from primary hypothyroidism with different rheumatic manifestations were evaluated.ResultsMale to female ratio was 1:3 with mean age of 27 (±4.6) years and the mean body mass index (BMI) was 29.3 (±3.4) kg/m². Musculoskeletal disorders observed were – body ache and myalgia in 100 (83.33%), muscle cramps and stiffness in 100 (83.33%), low back pain in 60 (50%), arthralgia in 30 (25%), adhesive capsulitis in 25 (20.8%), limited joint mobility in 20 (16.67%), myopathy in 10 (8.33%), carpal tunnel syndrome in 8 (6.6%), trigger finger in 5 (4.1%), Dupuytren's contracture in 4 (3.33%) and tarsal tunnel syndrome in two patients (1.6%). Rheumatologic disorders associated were – osteoarthritis in 80 (66.7%), mild inflammatory arthritis involving hand joints in 60 (50%), rheumatoid arthritis in 20 (16.67%), SLE in 10 (8.33%), fibromyalgia in 6 (5%), Raynaud's phenomenon in 2 (1.66%) and mixed connective tissue disease in 2 patients (1.66%). Other autoimmune disorders associated were vitiligo in 6 (5%), lichen planus in 4 (3.33%), recurrent aphthous stomatitis in 4 (3.33%) and alopecia areata in 4 patients (3.33%). Laboratory abnormalities detected were thyroid autoantibody (anti-TPO) in 40 (33.3%), elevated CPK enzyme in 40 (33.3%), rheumatoid factor in 14 (11.7%) and ANA in 4 (3.3%) cases.ConclusionRheumatic disorders in patients with primary hypothyroidism were significant disease manifestations and early identification along with effective management is essential.     

原发性甲状腺功能减退与肌酶谱的相关性研究

目的 探讨不同程度原发性甲状腺功能减退(甲减)对肌酶谱的影响,观察甲减患者激素替代治疗后肌酶谱的动态变化.方法 收集原发性甲减患者68例,其中亚临床甲减组21例,中度甲减组15例,重度甲减组32例,另选取39例健康体检者作为对照组.分别在初诊和激素替代治疗后1个月、2个月检测各组血清游离T3(FT3)、游离T4(FT4...     

Changes in cardiac function at rest before and after treatment in primary hypothyroidism

The aim of the present study was to investigate in hypothyroid patients the reversibility of the prolongation of electromechanical delay and of the impairment of early diastolic relaxation as measured by radionuclide ventriculography after restoration of euthyroidism. We also evaluated Doppler echocardiography in relation to scintigraphic findings. Twenty-six consecutive hypothyroid patients were studied at diagnosis and after treatment. The time to peak ejection decreased (161 +/- 6 vs 145 +/- 5 ms; p = 0.03) without changes in global systolic function (ejection fraction). The peak filling rate was reversible as well: 2.6 +/- 0.1 versus 3.0 +/- 0.2 end-diastolic volume/s; p = 0.003. No significant changes in systolic and diastolic cardiac function or ventricular geometry were detected by Doppler echocardiography. However, subanalysis of profoundly hypothyroid patients (free T4 < 4.5 pmol/L, n = 8) revealed a decrease in the septal wall thickness (9.9 +/- 0.7 vs 8.3 +/- 0.4 mm, p = 0.01) and increases in early peak transmitral inflow velocity (53 +/- 4 vs 65 +/- 4 cm/s, p = 0.03), as well as left ventricular end-diastolic diameter (4.8 +/- 0.1 vs 5.1 +/- 0.2 cm, p < 0.05) after treatment. Thus, in primary hypothyroidism, a subtle reversible prolongation of contraction without major changes in global systolic function and a decrease in early active relaxation is observed by radionuclide ventriculography. Echocardiography shows changes only in severely hypothyroid patients.     

Heart rate variability and heart rate turbulence in hypothyroidism before and after treatment

Background: Cardiac autonomic dysfunction may develop in patients with clinical or subclinical thyroid hormone deficiency. Heart rate variability (HRV) and heart rate turbulence (HRT) are used for evaluating changes in cardiac autonomic functions and also used to provide risk stratification in cardiac and noncardiac diseases. The aim of this study is to evaluate cardiac autonomic functions before and 6 months after thyroid replacement therapy in patients with thyroid hormone deficiency. Methods: Forty hypothyroid patients (mean age 48 ± 13, four male) and 31 healthy controls (mean age 51 ± 12, three male) were included in the study. Twenty‐four hour ambulatory electrocardiogram recordings were taken using Pathfinder Software Version V8.255 (Reynolds Medical). The time domain parameters of HRV analysis were performed using the Heart Rate Variability Software (version 4.2.0, Norav Medical Ltd, Israel). HRT parameters, Turbulence Onset (TO), and Turbulence Slope (TS) were calculated with HRT! View Version 0.60‐0.1 software. Results: HRV and HRT parameters were decreased in the patient group (SDNN; P < 0.001, SDANN; P < 0.009, RMSSD; P = 0.049, TO; P = 0.035, TS; P < 0.001). After 6 months of thyroid replacement therapy, there were no significant changes observed in either HRV or HRT. Conclusions: Hypothyroidism may cause cardiac autonomic dysfunction. Treating hypothyroidism with L‐thyroxine therapy does not effectively restore cardiac autonomic function. HRV and HRT can be used as to help monitor cardiovascular‐related risk in this population. Ann Noninvasive Electrocardiol 2011;16(4):344–350     

射频消融术前后血浆心肌酶变化的临床研究

目的 通过动态观察射频消融术患者血浆心肌酶的变化,评价射频消融术对心肌的损伤。方法 ６０例患者,男性２７例,女性３３例,年龄６￣６７岁,均无器质性心脏病。其中,房室结交界区折返性心动过速１６例,房室旁路参与的房室折返性心动过速３７例（左侧旁路２２例,右侧旁路１５例）,房性心动过速１例,特发性室性心动过速２例,心房扑动４例。分别在术前、术中、术后即刻及术后１ｄ采血３ｍｌ,测定血浆心肌酶的水平。结果     

Time-to-treatment significantly affects the extent of ST-segment resolution and myocardial blush in patients with acute myocardial infarction treated by primary angioplasty.

AIMS: The prognostic role of time-to-treatment in primary angioplasty is still a matter of debate. The aim of our study was to evaluate the relationship between time-to-treatment and myocardial perfusion in patients with ST-segment-elevation myocardial infarction (STEMI) treated by primary angioplasty. METHODS AND RESULTS: Our study population consisted of 1072 patients with STEMI treated by primary angioplasty from 1997 to 2001. Myocardial perfusion was evaluated by using ST-segment resolution and myocardial blush grade. Time-to-treatment was defined as the time from symptom-onset to the first balloon inflation. Time-to-treatment was significantly associated with the extent of ST-segment resolution, myocardial blush grade, enzymatic infarct size, and 1-year mortality. After adjustment for baseline confounding factors, time-to-treatment was still associated with impaired ST-segment resolution (adjusted OR [95% CI]=1.01 [1.01-1.02], p<0.001) and myocardial blush (adjusted OR [95% CI]=1.01 [1.01-1.02], p<0.0001). CONCLUSIONS: This study shows that in patients with STEMI treated by primary angioplasty prolonged ischaemic time is associated with impaired myocardial perfusion, larger infarct size, and higher 1-year mortality. Therefore, all efforts should be made to shorten ischaemic time as much as possible to achieve better myocardial perfusion and myocardial salvage in primary angioplasty for STEMI.     

原发性甲状腺功能减退所致认知功能损伤的可逆性分析

目的 探讨接受甲状腺激素替代治疗后激素水平恢复时患者认知功能损伤的可逆性.方法 进行纵向研究,入选甲状腺功能减退(甲减)患者20例,平均年龄(47.6±10.9)岁,进行6个月的甲状腺激素替代治疗,并选取与其相匹配的同年龄、同文化程度、同性别、甲状腺功能(甲功)正常对照者20名.对治疗前、后的甲功及认知功能损伤进行评估.结果 甲状腺激素替代治疗6个月后,甲减患者在神经心理学实验中的画钟表试验、图像记忆、摆积木、复杂图形复制、复杂图形回忆及图形延迟回忆、连线A、词表学习第1次、词表延迟回忆、词语再认、数字顺背、数字倒背、词语流畅性、数字符号实验均较治疗前有明显提高(P＜0.05),而词语学习第2次及第3次、连线B与治疗前相比无差异(P＞0.05).结论 经过甲状腺激素替代治疗,甲减所造成的认知功能损伤可恢复.