充血性心力衰竭患者甲状腺激素及心功能改变的临床研究

目的 探讨充血性心力衰竭(CHF)患者甲状腺激素变化和心功能的关系。方法 用放射免疫法测定36例CHF患者（CHF组）和同期健康体检者23例（正常对照组）血清三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)、反三碘甲状腺原氨酸(rT3)及促甲状腺素，用超声心动图测定心排血量(CO)、左心室射血分数(LVEF)、左心室舒张末容积(LVEDV)和左心室收缩末容积(LVESV)。结果 CHF组心功能Ⅲ、Ⅳ级患者（分别为16、10例）T3水平和LVEF、CO明显低于正常对照组T3：(1.6±0.2) nmol/L、(1.5±0.2)nmol/L 比(2.0±0.3) nmol/L,LVEF:(54.4±8.3)％、(51.3±11.1)％比(59.0±8.9)％,CO:(4.3±2.6) L/min、(4.1±2.6) L/min比(5.5±1.6) L/min，P＜0.05或P＜0.01]，rT3和LVEDV、LVESV明显高于正常对照组rT3:(0.6±0.3)nmol/L、(0.6±0.4)nmol/L比(0.3 ±0.1)nmol/L,LVEDV:(202±46)ml、(234±65)ml比(175±53) ml，LVESV：( 149±57) ml、(160±59)ml比(124±56)ml，P＜0.01]，且随着心力衰竭程度加重，其变化越明显。结论 甲状腺激素变化对CHF患者心功能损害程度、治疗及预后具有重要意义。

Clinical study of the relationship between thyroid hormone changes and cardiac function in congestive heart failure patients

Objective To explore the relationship between thyroid hormone (TH) changes and cardiac function in patients with congestive heart failure (CHF). Methods In CHF group (36 patients with CHF) and control group (23 non-CHF patients), three plasma triiodothyronine ( T3 ), four-triiodothyronine ( T4 ), thyroid iodine against three the original acid ( rT3 ) and thyroid stimulating hormone (TSH) were determined by radioimmunoassay ; cardiac output ( CO), left ventricular ejection fraction ( LVEF), left ventricular end diastolic volume ( LVEDV), left ventricular end systolic volume (LVESV) by echocardiography. Results In CHF group T3 levels and LVEF,CO were significantly lower than the control groupT3 : ( 1.6 ±0.2) nmol/L, ( 1.5 ±0.2)nmol/L vs (2.0 ±0.3)nmol/L,LVEF:(54.4±8.3)％,(51.3±11.1)％ vs (59.0±8.9)％,CO:(4.3 ±2.6)L/min,(4.1±2.6)L/min vs (5.5 ±1.6)L/min,P＜0.05 or P＜0. 01]; rT3, LVEDV and LVESV increased significantlyrT3 :(0.6 ± 0.3 ) nmoL/L, (0.6 ± 0.4) nmol/L vs (0.3 ± 0.1 ) nmol/L, LVEDV : (202 ± 46) ml, ( 234 ± 65 ) ml vs ( 175 ±53 ) ml, LVESV : ( 149 ± 57 ) ml, ( 160 ± 59) ml vs ( 124 ± 56 ) ml, P ＜ 0.01], and with the degree of heart failure increased,the more obvious changes. Conclusion TH changes have great significance on cardiac function damage,treatment and prognosis of patients with CHF.