小剂量甲状腺素对老年慢性心力衰竭伴低甲状腺素水平患者心功能的影响

目的　探讨小剂量甲状腺素对老年慢性心力衰竭(CHF)伴低甲状腺素水平患者心功能的影响。方法　通过测定老年CHF患者的甲状腺素水平,对4 2例符合正常甲状腺功能病态综合征患者,随机分为甲、乙两组。甲组(2 0例) :常规抗心力衰竭+小剂量甲状腺素治疗。乙组(2 2例) :常规抗心力衰竭治疗。比较两组入院时及6个月后左心室射血分数(LVEF)、左室舒张末期内径(LVDd)、E峰与A峰比(E/A)、6min步行试验,因心力衰竭再次住院次数,死亡例数,T3 、T4、FT3 、FT4水平,平均心率变化。结果　甲、乙两组治疗后LVEF、E/A、及6min步行试验均有提高,LVDd缩小,T3 、T4、FT3 、FT4纠正接近正常(P <0 .0 1) ,尤以甲组显著。两组治疗后LVEF、E/A、6min步行试验、LVDd和T3 、T4、FT3 、FT4有显著差异(P <0 .0 5 )。而两组治疗前后心率均显著降低(P <0 .0 1) ,但组间差异无显著性,甲组住院率及病死率均低于乙组(P <0 .0 1)。结论　小剂量甲状腺素治疗老年性心力衰竭伴正常甲状腺功能病态综合征患者安全有效,可改善其心功能,并降低再次住院率及病死率,且对心率无增快的副作用。

Effects of small doses of thyroxine on cardiac function in the elderly patients with congestive heart failure and low levels of thyroxine in serum

Objective To study the effects of small doses of thyroxine on cardiac function in the elderly patients with congestive heart failure and low levels of thyroxine in serum.Methods The serum content of thyroxine in the elderly with CHF was measured.Forty-two cases who accorded with the normal sick euthyroid syndrome were chosen.They were randomly divided into Group A (n=20) and B (n=22). Group A was treated with routine anti-heart failure treatment and small doses of thyroxine, while group B was treated with routine anti-heart failure treatment. LVEF?LVDd and E/A of the two groups were compared when they were hospitalized and after 6 months.6-minute walk test was performed.The number of times of rehospitalization because of heart failure, the cases of death, the levels of T_3,T_4,FT_3 and FT_4 in serum and the average changes of their heart rates were compared.Results After treatment, in both Group A and group B LVEF, E/A and the 6-minute walk test were improved, but LVDd decreased;T_3,T_4,FT_3 and FT_4 were corrected obviously and were close to normal(P<0.05),especially in group A(P<0.01). There were obvious differences between group A and group B in LVEF, LVDd, E/A, 6-minute walk test,and T_3,T_4,FT_3 and FT_4 (P<0.05).The heart rate of the two groups remarkably dropped(P<0.01), yet there were no marked differences between the two groups.Both the rate of hospitalization and the death rate in group A were lower than those in group B( P<0.01).Conclusion Small doses of thyroxine are safe and effective and can improve cardiac function and decrease the rate of rehospitalization and the death rate for congestive heart failure in the elderly patients with congestive heart failure,and do not increase heart rate.