甲状腺素和充血性心力衰竭的关系94例分析

目的：探讨充血性心力衰竭（ＣＨＦ）患者的甲状腺素变化及机制。方法：用放射兔疫法测定９４例患者的甲状腺素各成分，对比分析不同心功能状态下甲状腺素的变化。结果：ＣＨＦ时甲状腺素普遍降低，以ＦＴ３和ＴＴ３降低者最多，占７９．７％和８２．２％；随心衰的加重，甲状腺素进行性下降，以ＦＴ３、ＴＴ３、ＴＴ４降低程度最大，心功能Ⅳ级与心功能Ⅰ级比有显著性差异。肝肾瘀血较非瘀血者明显降低，组间有显著性差异。结论：ＣＨＦ时甲状腺素异常，以低Ｔ３综合征为主；甲状腺素降低程度与心衰程度成正比，γＴ３则与之相反。血浆内儿茶酚胺，糖皮质激素增高、肝肾功能异常，使Ｔ４转化为Ｔ３减少，是ＣＨＦ时甲状腺素降低的主要机制。

Analysis of the Relationship between Thyroxin And Congestive Heart Failure

Objective:To study the variation and mechanism of the thyroxin in congestive heart failure (CHF).Methods:Radioimmunoassay was applied to determine the levels of thyroxin in 94 cases of CHF and the variations of thyroxin in different state of heart function were contrasted and analyzed.Results:Thyroxin decreased when CHF occurred,with FT3 and TT3 cases taking up the majority by 79.7% and 82.2%.Thyroxin decreased progressively with the aggravation of CHF,of which the decreasing of FT3,TT3 and TT4 was significant.There was also significant difference between the heart function Grade 4 and that of Grade 1.Conclusion:When CHF occurs,thyroxin varies and T3 syndrome predominates.Thyroxin decrease is in direct ratio with CHF while T3 is in reverse ratio with CHF.The main mechanism of thyroxin decreasing consists in the decrease of cotecholamine and cortisol and the disorders of liver and kidney,which inverts T4 into T3 decrease.