82例甲状腺功能亢进患者的心电图分析

甲状腺功能亢进(甲亢)是内分泌系的常见病和多发病，常伴有心电图改变，此种改变可单独或合并存在。本文回顾分析1998年6月-2004年5月间甲亢资料完整、有心电图改变者82例。报告如下。     

62例甲状腺机能亢进的心电图改变

甲状腺机能亢进者常伴有心电图改变。国内外已有文献报导 ,此种改变可单独或复合存在。本文回顾分析 1994年 5月～ 2 0 0 0年 5月间 88例甲亢患者中有心电图改变 62例 ,现报告如下。1　资料与方法62例甲亢中 ,男 14例 ,女 48例 ,年龄在 2 0～ 5 5 (3 6 5± 9 4)岁。均为我院内分泌科门诊及收住院者 ,病程均在 1年以上 ,有明显的临床症状且血清ＦＴ3、ＦＴ4  ,ＴＳＨ  ,ＴｎＴＧ 正常 ,甲状腺Ｂ超检查排除甲状腺占位病变 ,检查前未服用抗心律失常药物。采用日本光电 65 11型心电图机。常规 12导联心电图检查。部分患者行心电向量检查 ,个…     

甲状腺机能亢进性心脏病并发房室传导阻滞心电图分析

本文总结 1995年 1月至 1998年 6月 3 60例住院甲亢病人 ,选择并发房室传导阻滞且资料完整的 9例 ,探讨其心电图变化特点及临床意义。1　资料与方法9例均有甲状腺Ⅱ -Ⅲ°肿大。其中 ,女 6例 ,男 3例 ,年龄 2 1～ 61(3 3 3 3±11 87)岁。病程 90ｄ至 2 2 2 0ｄ ,平均 3个月～ 6 0 8年。均采用放射免疫法测定血清甲状腺素的浓度 ,结果Ｔ3、Ｔ4、ＴＳＨ、甲状腺吸碘率及基础代谢率均异常。并除外影响房室传导功能的缺血性心脏病、心肌炎、原发性心肌病的存在。9例均做Ｘ线胸部正侧位摄片。左房左室大 1例 ,右室大 1例 ,其余 7例心影正常。超…     

甲状腺机能亢进症186例心电图分析

目的观察甲状腺机能亢进症(甲亢)患者心电图改变及其与病程、年龄的关系。方法对186例甲亢者的心电图进行分析。结果186例中有一种以上心电图改变165例(88．7％),其改变与病程、年龄有关。结论甲亢症心电图改变的原因在于甲亢本身,控制后大多数心电图改变可恢复正常。     

68例甲状腺功能亢进患者的心电图分析

本文对我院1998年～2004年68例甲状腺功能亢进(甲亢)患者的心电图资料分析,报告如下。     

甲状腺机能亢进的营养治疗及临床评估

目的观察甲状腺机能亢进患者通过营养干预组与对照组的治疗前后效果比较,看营养干预对甲状腺机能亢进患者是否有所帮助。方法我院2006年1月~2006年10月期间128名住院甲状腺机能亢进患者,自愿分成两组,一组为营养干预组,另一组为对照组,观察营养治疗在甲状腺机能亢进患者中的效果,并且监测患者FT3、FT4。结果营养干预组FT3、FT4全部降至正常水平的有52人,而对照组FT3、FT4降至正常水平有35人,根据卡方检验,P<0.005,应用营养治疗干预组的患者明显好于对照组。结论营养治疗对甲状腺机能亢进患者是非常必要的。     

甲状腺机能减退症患者心电图改变

甲状腺机能减退症(甲减)是内分泌疾病中一种常见病,多数起病隐袭,发展缓慢,症状可涉及全身各器官、各个系统,临床上有许多患者因胸闷、乏力、畏寒、心电图多因ST—T的改变,心律失常而就诊,但甲减患者心电图改变的报道不多。     

老年甲状腺功能亢进性心脏病的诊断及误诊分析

胜利石油管理局河口医院于1995年7月至2002年1月收治老年甲状腺功能亢进(甲亢)性心脏病20例,其中10例误诊,现将其报告如下,并简要分析误诊原因。 1 临床资料 1.1 一般资料 20例患者中:男性12例,女性8例。年龄55～81岁,平均61.2岁;9例有高血压病史,3     

甲状腺机能亢进与骨质疏松

骨质疏松是各种病因引起的一组代谢性骨病 ,其特点是单位体积内骨组织的蛋白质和钙、磷含量降低 ,骨皮质变薄 ,髓质骨小梁数目及大小均下降 ,骨髓腔变宽 ,骨负载能力降低。本病主要临床症状有腰背及四肢骨痛 ,脊柱畸形甚至骨折。甲状腺机能亢进症 (甲亢 )患者由于甲状腺素分泌过多 ,可引起高转换率性骨质疏松。国内外统计甲亢并发骨质疏松的发生率约为 2 0 %～ 5 0 %。1　甲状腺素在骨代谢中的作用正常骨骼旧骨不断吸收 ,新骨不断形成 ,处于一种动态平衡中 ,这种平衡主要由成骨细胞和破骨细胞完成。甲状腺素对成骨细胞和破骨细胞均有影响 ,…     

碘致性甲状腺机能亢进

1　概念1.1　甲状腺机能亢进 (甲亢 ,hyper-thyroidism )和甲状腺毒症 (thyrotoxi-cosis) :甲亢是指伴有甲状腺激素生成过多所致甲状腺功能增强的综合症 (或状态 ) ,甲状腺毒症是机体组织在过多甲状腺激素作用下处于的一种“中毒”状态。一般情况下 ,两个术语没有什么区别 ,可互用。严格讲 ,甲状腺毒症是一种甲状腺激素过多疾病的总称 ,甲亢是其中的一种 ,仅是甲状腺本身亢进而分泌过多的甲状腺激素所造成的甲状腺毒症。1.2　碘致性甲状腺机能亢进 (Iodine-induced hyperthyroidism,IIH)　是指与摄碘量增加有关的甲亢 ,简称碘性甲亢 ,又称…     

Cardiovascular and electrocardiographic changes in Nigerians with a normal pregnancy

Introduction

Pregnancy is associated with major haemodynamic and cardiac changes, which can mimic or precipitate cardiac diseases. There is a paucity of this kind of data among pregnant Nigerian women. This study was aimed at describing the cardiovascular and electrocardiographic changes found among healthy pregnant Nigerian women.

Methods

This was an age-matched control study of 69 consecutive normal pregnant and 70 healthy non-pregnant controls. The study protocol included history, physical examination and 12-lead electrocardiography.

Results

Diastolic blood pressure < 60 mmHg was significantly commoner among pregnant subjects than controls (64.7 vs 24.3%, respectively, p < 0.005). Mean heart rate was higher among pregnant women (88.34 ± 11.46 bpm) than the controls (75.16 ± 12.22 bpm, p = 0.020). Pregnant subjects also had a higher proportion of left ventricular hypertrophy (LVH) (10.2 vs 0%, p < 0.05) than non-pregnant controls. Abnormal cardiac findings included a loud second heart sound (P₂), missed beats and systolic murmurs (41.2% in pregnant subjects vs 12.9% in non-pregnant controls, p < 0.05). Negroid-pattern ST-segment elevation was commoner among controls (24.3%) than pregnant subjects (2.9%, p < 0.005). Arrhythmias were rare among the study participants.

Conclusion

Significant findings on examination were low diastolic blood pressure and a systolic ejection murmur. However, ECG changes showed a normal frontal-plane QRS axis, normal PR interval, significantly rare normal Negroidpattern ST elevation, significant LVH based on Araoye RI > 12 mm and a rarity of all forms of arrhythmias. These data may help resolve some cardiac diagnostic difficulties during pregnancy.     

Simple anatomical basis for surface electrocardiographic changes during selective coronary arteriography

The relationship between surface electrocardiographs changesduring selective coronary arteriography and coronary arteryanatomy was examined in 185 consecutive patients. When bothmajor arteries were patent, two distinct patterns of electrocardiographschanges occurred. Electrocardiogram leads reflecting the areassupplied by the injected vessels showed a change we have termedthe ‘perfusion response’, while electrocardiogramleads reflecting regions not supplied by the injected vesselsimultaneously showed a pattern we have termed the ‘reciprocalresponse’. These changes were reproducible on serial injections,and occurred whether or not coronary artery or valvular heartdisease was present. A third type of electrocardiographic change—termed a ‘biphasic response’ and comprising a reciprocalfollowed by a perfusion response — was observed in leadsreflecting a collateral-dependent region of viable myocardium.This response was seen in the inferior surface leads with leftcoronary artery injection when the right coronary artery wasoccluded, but not in leads I andaVL with right coronary arteryinjection when a branch of the left coronary artery was occluded,where chest leads may be needed for its detection. The biphasicresponse was also seen in the inferior leads with left coronaryartery injection in patients in whom this artery was dominant. Thus, the distribution of electrocardiographic changes duringarteriography is dependent on native coronary artery anatomy,collateral vessels and myocardial viability. Changes relateto the site of coronary lesions only where vessels are occluded,but may be of practical value when the viability of (and thussuitability for bypass grafting to) a myocardial region is indoubt.     

中青年甲状腺功能亢进患者骨密度特点

目的分析中青年甲状腺功能亢进(甲亢)患者骨密度特点及其与病程、病情严重程度的关系。方法使用双能X线骨密度仪分别测定340例中青年甲亢患者及160名年龄匹配的正常对照者的前臂、腰椎及股骨颈骨密度,用化学发光法测定甲亢患者游离三碘甲腺原氨酸(FT3)、游离甲状腺激素(FT4)及促甲状腺激素(TSH),用自动生化仪检测血清钙(Ca)、血清磷(P)、碱性磷酸酶(ALP),比较2组间骨密度及Ca、P、ALP的差异。根据国际临床骨密度学会(ISCD)和国际骨质疏松基金会(IOF)对中青年骨质疏松诊断的不同定义分别将甲亢患者分为骨量正常组(ON1)和骨质疏松组(OP1)、骨量正常组(ON2)、骨量减少组(OD2)、骨质疏松组(OP2),比较使用2种诊断方法得出的骨质疏松检出率,比较各组甲状腺激素(TH)及TSH的差异。结果与正常对照组相比,甲亢患者桡骨全部、腰椎L2-4及股骨颈骨密度均明显降低(均P0.05)。根据ISCD定义得出的骨质疏松检出率为46.8%,根据IOF定义得出的骨质疏松检出率为27.1%,前臂较腰椎、股骨颈骨密度降低更明显。甲亢患者骨质疏松组较骨量正常组的FT3、FT4明显升高(P0.05),TSH明显降低(P0.05)。多元线性回归分析显示桡骨骨密度与FT4、Ca呈负相关,与TSH呈正相关。结论中青年甲亢患者骨质疏松患病率高,骨量丢失较明显的部位为桡骨,过量甲状腺激素及低TSH均可导致骨代谢紊乱。     

心电阶梯现象的病因初探

本文对近年文献报道的心电阶梯现象及本院所发现的心电阶梯现象共21例进行病因总结和分析。分析心电阶梯现象的病因及临床意义。结果显示心电阶梯现象的出现,绝大部分都提示心肌有广泛而严重的病变,仅极少数出现于与心脏无关的疾病或心脏无明显损害者。     

中青年甲亢患者心电图分析

目的 探讨心电图变化对中青年甲亢的诊断价值。方法 对我院门诊就诊且初次诊断为甲亢的75例患者的心电图资料进行分析,并且选择75例来我院体检,性别、年龄匹配的正常人群的心电图资料作为对照。结果 甲亢组患者心电图改变37例(49.33%),正常对照组心电图改变23例(30.67%),两组差异有统计学意义(P<0.05),且心电图改变主要为ST段、T波的改变。甲亢组心率明显快于正常对照组,甲亢组心率(77.72±12.98)次/min,正常对照组心率(71.29±10.14)次/min,两组差异有统计学意义。甲亢患者中,心电图异常率女性患者(61.70%)明显高于男性患者(32.14%),两者比较差异有统计学意义。甲亢组相对于对照组QT间期缩短、QTc间期延长、P波振幅增高,两组比较差异有统计学意义。结论 甲亢患者心电图异常发生率比对照组高,心电图对甲亢的诊断有一定的参考价值。     

Ambulatory 24-hour continuous electrocardiographic monitoring in 54 patients with ankylosing spondylitis

Of 54 patients with ankylosing spondylitis 48 were found to be HLA B27 positive. Ambulatory 24-hour Holter monitoring revealed electrocardiographic 'abnormalities' in 12 of the 48 HLA B27 positive patients. To our knowledge this is the first ambulatory Holter monitoring of a group of patients with ankylosing spondylitis, and the outcome seems to suggest a relationship between the tissue type HLA B27 and the occurrence of electrocardiographic 'abnormalities'. The frequency of atrioventricular block (types I and III) and atrial tachycardia was significantly higher in this group of patients than that found in similar studies of healthy adults. The frequency of psoriasis and cardiac murmurs was increased among the patients with electrocardiographic 'abnormalities'.     

85例肺栓塞临床心电图分析

目的 分析心电图改变在临床肺栓塞诊断中的作用。方法 病例选自我院1995年1月至2003年2月期间住院的85例经肺CT、灌注／通气扫描或肺动脉造影明确诊断的肺栓塞患者，主要分析患者住院期间的心电图特征以及治疗前后心电图改变的对比。结果 肺栓塞患者出现心电图改变者为98．8％，其中最多见的为QⅢ，达到60．0％，其它SI 55．3％，TⅢ 44．7％，同时具备SⅠQⅢTⅢ占32．9％，右胸导联Vl—V3T波倒置占42．4％，aVR导联出现终末R波占36．5％，右束支阻滞占25．9％，ST段下移改变占25．9％，肺型P波仅占5．9％。结论 心电图在临床肺栓塞的诊断虽然是非特异性和非诊断性的，但有许多特征对提示肺栓塞有一定价值。     

Association of inflammation with atrial fibrillation in hyperthyroidism

Objectives The aim of this study was to evaluate the relationship between inflammation and development of atrial fibrillation (AF) in patients with hyperthyroidism. Methods A total of 65 patients with newly diagnosed hyperthyroidism, 35 of whom were in sinus rhythm and 30 of whom in AF. Thirty five age- and gender-matched patients in a control group were included in the study. Factors associated with the development of AF were evaluated by multivariate regression analysis. Results Factors associated with AF in multivariate analysis included high sensitivity C reactive protein [(HsCRP); odds ratio (OR): 11.19; 95% confidence interval (95% CI): 1.80-69.53; P = 0.003], free T4 (OR: 8.76; 95% CI: 2.09–36.7; P = 0.003), and left atrial diameter (OR: 1.25; 95% CI: 1.06–1.47; P = 0.008). Conclusions The results of the present study suggest that high sensitivity C reactive protein, an indicator of inflammation, free T4 and left atrial diameter are associated with the development AF in patients with hyperthyroidism.     

Liver changes in patients with hyperthyroidism

We studied liver changes in the hepatic biopsies of five patients with hyperthyroidism. A characteristic histopathologic picture consisting of mild to moderate intrahepatocytic cholestasis, lobular inflammatory infiltrate with some eosinophils, and Kupffer cell hyperplasia was found in all cases. We discuss the specificity, clinicopathological correlations and the possible pathophysiology of these lesions.