Hyperthyroidism and the heart: study of left ventricular function in preclinical hyperthyroidism

To study the response of the target organs to minor increments of thyroid hormone levels, left ventricular ejection fraction (LVEF) the primary indicator of left ventricular function, was measured in patients with preclinical hyperthyroidism and the results were compared with those obtained in euthyroid subjects and in patients with toxic adenoma. In euthyroid subjects and in patients with preclinical hyperthyroidism LVEF in response to exercise involving an isometric static work load revealed a minor increase, whereas in manifest hyperthyroidism (toxic adenoma) an opposite response with an impairment of left ventricular functional capacity was found. The results showed that the pituitary responds more sensitively to minor changes in the circulating thyroid hormone levels than does the heart and indicated that the typical hyperthyroid heart changes associated with the evolution of toxic adenoma develop gradually.     

Hypothyroidism and the heart. Examination of left ventricular function in subclinical hypothyroidism

For revealing whether cardiac performance is changed in subclinical hypothyroidism, the left ventricular ejection fraction (LVEF), a value characterizing left ventricular function, was studied in this clinical state. The results were compared to those obtained in euthyroid subjects and patients with overt hypothyroidism. In a part of subclinical cases, there is a subnormal resting LVEF, which on isometric exercise, increases, but to a lesser extent than in euthyroid controls. In overt hypothyroidism resting LVEF is considerably lower than in euthyroid and subclinically hypothyroid subjects and its value does not respond to exercise. There has been evidence that heterogeneous subclinical hypothyroidism is an intermediate state between euthyroidism and overt hypothyroidism; the majority of patients are euthyroid, a part of them, however, based on systolic time intervals and LVEF studies, are suspect of developing 'tissue' hypothyroidism, although their serum thyroid hormone level is still within normal limits.     

血浆脑钠素水平与心衰患者左心功能关系的临床研究

为探讨血浆脑钠素(BNP)水平与心力衰竭患者临床心功能变化之间的关系,本文采用IRMA法测定患者血浆BNP水平,同时采用NYHA心功能分级和超声心动图检查评定患者左心功能。结果表明,随着心功能恶化,血浆BNP水平呈上升趋势。各级心功能间均有显著性差异(P<0.05)。经抗心衰药物综合治疗后,BNP水平降低(P<0.01)。BNP水平与左心室射血分数(LVEF)、左心室短轴缩短率(△D%)呈负相关;与左室收缩末内径(LVDS)、左室舒张末内径(LVDd)呈正相关。总之,在患者心力衰竭的进展中其血浆中BNP水平与心衰程度密切相关,测定患者血浆BNP水平是监测心衰程度的有效手段之一。     

血浆IL-35水平评价冠心病及其与冠脉Gensini积分和LVEF的相关性

目的 探讨白细胞介素35(interleukin-35,IL-35)评价冠心病及其与Gensini积分和左心室射血分数(left ventricular ejection fraction,LVEF)的相关性.方法 选取2014年1月至2015年12月经冠状动脉造影术(CAG)确诊为冠心病的患者90例,按临床分型,其中稳定型心绞痛(SAP) 25例,不稳定型心绞痛(UAP) 33例,急性心肌梗死(AMI) 32例;选择同期CAG结果提示冠状动脉管腔直径狭窄率＜50％的患者50例为对照组.采用酶联免疫法检测血浆IL-35水平,比较冠心病患者与对照组之间的差异.结果 与对照组比较,SAP、UAP和AMI组的IL-35水平、冠脉Gensini积分差异均具有统计学意义(P＜0.05);与对照组比较,UAP组的左心室射血分数差异无统计学意义(P＞0.05),SAP、AMI组的左心室射血分数差异有统计学意义(P＜0.05).IL-35水平与冠脉Gensini积分不相关(r=0.28,P＞0.05),但与LVEF呈正相关性(r =0.41,P＜0.01).结论 IL-35水平与冠心病密切相关,可作为CHD评价和预后的指标.     

The relation between viable segments and left ventricular ejection fraction improvement

For patients with coronary artery disease and left ventricular dysfunction who undergo revascularization, it is important to estimate the left ventricular ejection fraction (LVEF) improvement after revascularization, as this is a strong indicator of the long-term outcome. Identification of viable segments from echocardiography has been considered a predictive sign of LVEF improvement. However, a quantitative relation between segmental function recovery and global ejection fraction improvement has not been established. There is a clinical need to determine parameters that are predictive to LVEF improvement. A cylindrical left ventricular model is proposed to establish the relation between segmental myocardial function and LVEF based on a 12-segment echocardiograph model. Model results show that LVEF improvement is directly related to the contraction ratio in normal segments and a weighted sum of the number of viable segments that recover to normal or hypokinetic, which is equal to a weighted sum of the change in wall motion scores. This new combined parameter is a better predictor of the amount of LVEF improvement than the total number of viable segments or preoperative ejection fraction. The predictive value of the model was illustrated in a group of four patients with coronary artery disease who underwent revascularization.     

Effects of growth hormone treatment on thyroid function in pediatric patients with Prader–Willi syndrome

It is unclear whether hypothyroidism is present in patients with Prader–Willi syndrome (PWS). This study aimed to clarify the state of the hypothalamic–pituitary–thyroid axis and the effects of growth hormone (GH) treatment on thyroid function in pediatric patients with PWS. We retrospectively evaluated thyroid function in 51 patients with PWS before GH treatment using a thyroid‐releasing hormone (TRH) stimulation test (29 males and 22 females; median age, 22 months). We also evaluated the effect of GH therapy on thyroid function by comparing serum free triiodothyronine (fT3), free thyroxine (fT4), and thyroid stimulating hormone (TSH) levels at baseline, 1 year, and 2 years after GH therapy. TSH, fT4, and fT3 levels were 2.28 μU/ml (interquartile range [IQR]; 1.19–3.61), 1.18 ng/dl (IQR; 1.02–1.24), and 4.02 pg/dl (IQR; 3.54–4.40) at baseline, respectively. In 49 of 51 patients, the TSH response to TRH administration showed a physiologically normal pattern; in two patients (4.0%), the pattern suggested hypothalamic hypothyroidism (delayed and prolonged TSH peak after TRH administration). TSH, fT4, and fT3 levels did not change significantly during 1 or 2 years after GH treatment. The TSH response to TRH showed a normal pattern in most patients, and thyroid function did not change significantly during the 2 years after initiating GH treatment.     

Handcycling: different modes and gear ratios

For patients with coronary artery disease and left ventricular dysfunction who undergo revascularization, it is important to estimate the left ventricular ejection fraction (LVEF) improvement after revascularization, as this is a strong indicator of the long-term outcome. Identification of viable segments from echocardiography has been considered a predictive sign of LVEF improvement. However, a quantitative relation between segmental function recovery and global ejection fraction improvement has not been established. There is a clinical need to determine parameters that are predictive to LVEF improvement. A cylindrical left ventricular model is proposed to establish the relation between segmental myocardial function and LVEF based on a 12-segment echocardiograph model. Model results show that LVEF improvement is directly related to the contraction ratio in normal segments and a weighted sum of the number of viable segments that recover to normal or hypokinetic, which is equal to a weighted sum of the change in wall motion scores. This new combined parameter is a better predictor of the amount of LVEF improvement than the total number of viable segments or preoperative ejection fraction. The predictive value of the model was illustrated in a group of four patients with coronary artery disease who underwent revascularization.     

Thyroid function in multidrug-resistant tuberculosis patients with or without human immunodeficiency virus (HIV) infection before commencement of MDR-TB drug regimen

BackgroundMycobacterium tuberculosis and human immunodeficiency virus (HIV) are known to cause abnormal thyroid function. There is little information on whether HIV infection aggravates alteration of thyroid function in patients with MDR-TB.ObjectivesThis study was carried out to determine if HIV co-infection alters serum levels of thyroid hormones (T3, T4) and thyroid stimulating hormone (TSH) in patients with MDR-TB patients and to find out the frequency of subclinical thyroid dysfunction before the commencement of MDR-TB therapy.MethodsThis observational and cross-sectional study involved all the newly admitted patients in MDR-TB Referral Centre, University College Hospital, Ibadan, Nigeria between July 2010 and December 2014. Serum levels of thyroid stimulating hormone (TSH), free thyroxine (fT4) and free triiodothyronine (fT3) were determined using ELISA.ResultsEnrolled were 115 patients with MDR-TB, out of which 22 (19.13%) had MDR-TB/HIV co-infection. Sick euthyroid syndrome (SES), subclinical hypothyroidism and subclinical hyperthyroidism were observed in 5 (4.35%), 9 (7.83%) and 2 (1.74%) patients respectively. The median level of TSH was insignificantly higher while the median levels of T3 and T4 were insignificantly lower in patients with MDR-TB/HIV co-infection compared with patients with MDRT-TB only.ConclusionIt could be concluded from this study that patients with MDR-TB/HIV co-infection have a similar thyroid function as patients having MDR-TB without HIV infection before commencement of MDR-TB drug regimen. Also, there is a possibility of subclinical thyroid dysfunction in patients with MDR-TB/HIV co-infection even, before the commencement of MDR-TB therapy.     

Economical and rational in vivo and in vitro diagnosis in Basedow hyperthyroidism

Immunogenic hyperthyroidism (Graves' disease) is a life-long ailment. A widespread diagnostic evaluation is essential for unbiased initial values prior to therapy. The major goals of initial investigation are to determine a functional disturbance of the organ, its pathogenesis and morphology. Even a suppressed ultrasensitive bTSH value represents no evidence of overt hyperthyroidism; a positive diagnosis can only be established by the additional presence of increased parameters of circulating free thyroid hormones (fT3, fT4). Evidence of any immunogenic pathogenesis is given by positive thyroid antibody values (TRAK, MAK, TAK). Moreover, the use of sonography (with poor diffuse echo and increased thyroid depth) as well as Tc-99m scan indicating primary autonomy, thyroxine induced hyperthyroidism or painless thyroiditis) may both prove rather useful in a rational and economical diagnosis of Graves' disease.     

不同起搏部位对左心室重构及左心收缩功能的影响

目的 研究右室间隔起搏及传统右室心尖部起搏对左心室重构及左心收缩功能的影响。方法 收集2013年1月~2015年5月曾于亳州市人民医院心内科行双腔起搏器植入术且随访资料完整的患者共63例,其中右室间隔起搏组共32例,右室心尖部起搏组共31例,观察两组术前与术后1年左室舒张末容积、左室射血分数、及血清NT-proBNP水平变化。结果 两组起搏器植入术前血清NT-proBNP水平及左室舒张末期内径和左室射血分数比较,差异无统计学意义（P＞0.05）,术后1年随访检测血清NT-proBNP水平,右室心尖部起搏组较右心室间隔部组升高（P＜0.05）;右心室间隔部起搏组术后左室舒张末期内径和左室射血分数与术前比较,差异无统计学意义（P＞0.05）;右室心尖部起搏组术后1年左室舒张末期内径较术前增大,左室射血分数减小（P＜0.05）。结论 相较于传统的右室心尖部起搏,右室间隔部起搏更能保证心室正常的电活动顺序,且对左室收缩功能的影响较小。     

Erythrocyte carbonic anhydrase I and zinc concentrations in thyrotoxicosis reflect integrated thyroid hormone levels over the previous few months

In the present review, the clinical utility of determining red blood cell (RBC) carbonic anhydrase I isozyme (CA1) and zinc(Zn) concentrations in patients with various forms of thyroid disease is discussed. RBC CAI and Zn concentrations were both decreased in patients with hyperthyroid Graves' disease. After treatment, the normalization of RBC CA1 and Zn lagged two months behind the normalization of plasma thyroxine (T4) and triiodothyronine (T3) levels. Furthermore, the highest correlation coefficients were observed between RBC CA1 and Zn levels, and plasma thyroid hormone levels measured eight weeks earlier. These results indicate that both RBC CAI and zinc levels reflect integrated plasma thyroid hormone levels over the previous few months. Transient thyrotoxicosis due to destructive thyroiditis did not cause significant changes in RBC CA1 and Zn concentrations. T3 at a physiological free concentration significantly decreased the level of CAl mRNA and the concentration of CA1 in burst forming unit erythroid-derived cells. These results indicate that the measurement of RBC CA1 and Zn concentrations may be useful as follows: (1) to obtain an accurate estimate of the extent of elevated thyroid hormone levels in hyperthyroid patients in whom serial measurements were not obtained over time; (2) to differentiate patients with hyperthyroid Graves' disease from those with transient thyrotoxicosis.     

AMI患者血浆NT-proBNP含量的变化及其与心功能的相关性研究

目的:探讨急性心肌梗死(AMI)患者血浆N末端脑钠肽原(NT-proBNP)水平的变化及其与心功能指标的相关性.方法:采用荧光免疫分析对189例AMI患者及55例健康对照者进行血浆NT-proBNP测定,同时以彩色多普勒超声心电动仪测定AMI患者左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、左心室...     

VVI及DDD起搏术对病态窦房结综合征患者血清NT-proBNP水平及左心功能的影响

目的:观察右心室起搏术(VVI)及双心腔起搏术(DDD)对病窦综合征(SSS)患者血清N-末端脑钠肽前体(NT-proBNP)水平和左心功能的影响。方法:118例患者被分为VVI组(68例)和DDD组(50例)。术前及术后三个月观察比较两组患者血清NT-proBNP水平、左室射血分数(LVEF)及二尖瓣血流频谱E峰、A峰比值(E/A)的差异。结果:术后三个月,VVI组血清NT-proBNP水平由术前128.05±50.16pg/ml升至381.26±70.22pg/ml,LVEF由术前58.65±3.82%降至42.32±4.42%,E/A由术前0.98±0.23降至0.67±0.16(P均<0.05);DDD组术后三个月血清NT-proBNP、LVEF及E/A与术前比较均无统计学差异。结论:DDD起搏术对左心功能影响小,而VVI影响较大,建议选用DDD。     

非体外循环下冠状动脉旁路移植围术期血浆脑钠肽释放及其相关性研究

背景：B型脑钠肽已成为心血管疾病诊断重要的血清标志物,作为心血管疾病危险因素分层的重要因子。 目的：分析冠状动脉旁路移植前后B型脑钠肽与各项血流动力学参数的关系。 方法：选择30例冠心病行冠脉旁路移植患者,分为左室射血分数≥ 50%心功能正常患者13例;左室射血分数< 50%心功能不全患者17例。观察患者移植前1 d、移植后7 h、移植后1,3,5,7 d血浆B型脑钠肽水平变化趋势,分析移植前后B型脑钠肽与心功能各项指标的相关关系。 结果与结论：左室射血分数≥ 50%组患者冠脉旁路移植前后血浆B型脑钠肽水平显著低于左室射血分数< 50%组;组内比较移植后血浆B型脑钠肽水平均显著高于移植前(P < 0.05或P < 0.001)。患者冠脉旁路移植前B型脑钠肽水平与纽约心脏病协会心功能分级、左房内径、左室内径呈正相关(r=0.61;r=0．34;r=0．67);与左室射血分数、心排血量呈负相关(r=-0.75;r=-0.70)。患者移植后B型脑钠肽峰值浓度与出院前纽约心脏病协会心功能分级、超声心动图左室舒张末期内径、肺动脉压力呈正相关(r=0.72;r=0.70;r=0.45)。结果说明冠心病患者冠脉旁路移植前血浆B型脑钠肽质量浓度与左心室射血分数及左心室舒张末期内径有很好的相关性,能准确反映冠脉旁路移植前后的心功能状态。 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程全文链接：     

The Effects of Hormones of the Hypothalamo-Hypophyseal-Adrenal, Renin-Angiotensin, and Thyroid Hormone Systems on the Formation of Dyscirculatory Encephalopathy

Measurements were made of plasma levels of free (f) thyroxine (fT4), triiodothyronine (fT3), thyrotropic hormone (TSH), adrenocorticotrophic hormone (ACTH), aldosterone, and renin in patients with dyscirculatory encephalopathy (DE). Their influences on the development of chronic circulatory insufficiency were assessed. A total of 39 patients were studied (aged 45-73 years) with DE stages I and II, without acute or chronic (in the exacerbation phase) somatic illness. These observations showed that diffuse lesions of brain tissues of different severities were accompanied by the following changes in thyroid homeostasis: 1) significant combined increases in TSH without alteration to the "fT3-TSH" negative feedback regulatory mechanism in patients with stage I DE; 2) significant combined decreases in TSH levels with marked suppression of the conversion of thyroxine into triiodothyronine and an interaction with impairments in the "fT3-hypophysis" system in patients with stage II DE. In addition, there were changes (increases) in cortisol levels with simultaneous decreases in renin levels in patients with stage II DE as compared with patients with stage I DE. Correlation analysis demonstrated the absence of any relationship between the age of the patients, the state of hormonal homeostasis, and the extent of vascular stenosis. These results suggest a role for hormones of the hypothalamo-hypophyseal-adrenal, thyroid, and renin-angiotensin systems in the mechanism by which DE develops as well as the possibility of using tests for these hormones as additional criteria for assessing the severity of diffuse brain lesions.     

超声心动图评价高血压患者血清脂联素水平与左心室心肌质量和舒张功能的关系

目的探讨高血压患者血清脂联素水平对左心室心肌质量(LVM)及舒张功能的影响。方法入选单纯高血压患者65例(其中男性36例,女性29例;年龄34～78岁,平均年龄53.78岁)和正常对照组33例(其中男性17例,女性16例;年龄32～65岁,平均年龄52岁)。采用酶联免疫吸附分析法测定血清脂联素水平。采用超声心动图测定LVM、左心室射血分数和代表左心室舒张功能的指标E/e比值、舒张早期左心室内血流传播速度(Vp)和左心室Tei指数。结果高血压组左心室心肌质量指数显著高于正常对照组[(123.58±45.40)g/m2 vs(87.29±17.40)g/m2;P<0.05]。高血压组Vp显著低于正常对照组[(41.25±9.86)cm/s vs(56.31±8.79)cm/s,P<0.01],而E/e比值和Tei指数显著高于正常对照组(8.28±1.96 vs 7.26±1.56,0.46±0.15 vs 0.39±0.12;P<0.05)。在高血压组中血清脂联素水平与左心室心肌质量指数、E/e比值和Tei指数均呈显著负相关(r分别为-0.36、-0.56、-0.58,P<0.05),而与Vp呈显著正相关(r为0.67,P=0.023)。多元逐步回归分析表明血清脂联素水平能分别进入以Vp和Tei指数为因变量的回归方程中。结论血清脂联素水平与左心室心肌质量指数呈显著负相关,血清脂联素水平降低是导致左心室舒张功能降低的危险因素之一。     

螺内酯联合曲美他嗪治疗慢性心力衰竭的疗效分析

目的 探讨螺内酯联合曲美他治疗善慢性心力衰竭患者的远期预后疗效及其改善患者心功能的作用。方法 选取2016年2月~2016年8月我院收治的CHF患者86例为研究对象,随机分为观察组和对照组,各43例,对照组予常规抗心衰治疗,观察组在常规抗心衰治疗基础上加用螺内酯20 mg/d联合曲美他嗪20 mg tid服12个月,观察治疗前后两组患者左室射血分数（LVEF）、6 min步行试验（6MWD）、NYHA心功能分级、左室结构功能指标及BNP变化水平。结果 治疗后NYHA心功能分级比较观察组优于对照组,差异有统计学意义（P＜0.05）;治疗后观察组LVEF、6MWD较对照组有明显升高,BNP较对照组下降明显,差异有统计学意义（P＜0.05）;治疗后观察组LVESD及LVEDD较对照组有明显缩短,LVESV较对照组有明显降低,差异均有统计学意义（P＜0.05）。结论 对慢性心力衰竭患者加用螺内酯联合曲美他嗪治疗,能够改善患者临床症状和心功能,同时改善患者左室结构和功能及远期预后,值得推广。     

无创血流动力学监测对早期HFpEF患者肺血流动力学指标及心室功能的评估价值

目的:探讨无创血流动力学监测在评估早期左室射血分数保留型心力衰竭(Heart failure with preserved ejection fraction,HFpEF)患者肺血流动力学指标及心室功能中的应用价值。方法:选取2018年1月至2019年8月来我院心内科就诊的99例患者为研究对象,按左室舒张功能分为HFpEF组(n=45)和无心衰症状的左室舒张功能障碍(Left ventricular diastolic dysfunction,LVDD)组(n=44)。所有患者均采用免疫放射分析法测定血浆脑利钠肽(Brain natriuretic peptide,BNP)水平,并采用心脏超声组织多普勒检测和无创血流动力学监测肺血流动力学,比较两组患者相关指标之间的差异。结果:HFpEF组血浆BNP水平明显高于LVDD组(P<0.05),左室射血分数(Left ventricular ejection fraction,LVEF)明显低于LVDD组(P<0.05),而左房内径(Left atrial diameter,LAD)、左室舒张末内径(Left ventricular end-diastolic diameter,LVEDd)、左室短轴缩短率(Fractional shortening,FS)组间比较差异无统计学意义(P>0.05);心室射血前期指数(Ventricular ejection farction,Q-BI)、心室射血期指数(Ventricular ejection duration index,B-YI)、心肌紧张指数(Myocardial tension index,Q-B/B-Y)、肺平均动脉压(Mean pulmonary arterial pressure,PAP)明显高于LVDD组(P<0.05)。结论:无创血流动力学监测应用于早期HFpEF患者,能准确评估疾病发展过程中肺血流动力学指标变化情况。     

Long-term pathologic changes of alpha1-acid glycoprotein (orosomucoid) glycoforms in autoimmune thyroid disease

OBJECTIVE: We measured alpha1-acid-glycoprotein (AGP) in patients with autoimmune thyroid disease to study a possible relationship between microheterogeneity of the naturally occurring glycoforms of AGP and autoimmune thyroid disease. DESIGN, PATIENTS, MEASUREMENTS: In a group of 12 fasting thyrotoxic patients (11 females, mean age: 43 years) with newly diagnosed Graves' disease (subgroup 1), we measured serum concentrations of total AGP and its 3 glycoforms (micromol/l, crossed affinity immunoelectrophoresis with con A in the first dimension gel) as well as total thyroxine, total triiodothyronine, thyrotropine, thyroid peroxidase antibodies (anti-TPO), antibodies against the TSH receptor (TRAb, TRAK), at baseline and after 12 months of antithyroid drug therapy (ATD). For comparison, 4 subgroups of thyroid patients (patients with Graves' disease and thyroid associated ophthalmopathy (TAO) (subgroup 2, n = 10), radioiodine treated Graves' patients (subgroup 3, n = 7), Graves' patients without TAO (subgroup 4, n = 13), patients with Hashimoto's thyroiditis (subgroup 5, n = 8)) and 25 normal controls (17 females, mean age: 38 years) were studied. RESULTS: In subgroups of TRAb positive Graves patients' serum levels of glycoform 1, 2 or 3 increased significantly (p < 0.005) after 12 months of ATD as compared to both baseline of that person or normal controls. No significant changes were found in the TRAb negative Hashimoto subgroup. CONCLUSION: Patients with autoimmune Graves' disease changed their relationship to AGP, and thus a role of AGP and its 3 glycoforms is suggested in the pathogenesis of Graves' disease.     

充血性心力衰竭患者血浆N末端脑钠肽前体水平与心功能关系的探讨

探讨充血性心力衰竭（CHF）患者血浆氨基末端脑钠肽前体（NT-proBNP）水平与心功能的关系。选择心衰患者（心衰组）108例,正常体检者（对照组）30名,采用电化学发光免疫分析技术（ECLIA）检测血浆NT-proBNP水平,用超声心动图测定心衰患者的左心室射血分数（LVEF）。结果表明：心衰组血浆NT-proBNP水平显著高于对照组（P〈0.01）,并且血浆NT-proBNP浓度随着心功能分级（NYHA分级）的增加而升高（均P〈0.01）,而与LVEF呈负相关（r=-0.633,P〈0.01）。血浆NT-proBNP水平可作为CHF患者心功能检测的有效生化指标,并与心脏功能之间有较好的相关性。