左甲状腺素替代治疗充血性心力衰竭伴低T3综合征患者56例

目的分析充血性心力衰竭(CHF)患者甲状腺激素水平变化特点,观察左甲状腺素替代治疗充血性心力衰竭伴低T3综合征患者的疗效。方法将56例CHF伴低T3综合征患者随机分为对照组和治疗组。对照组给予常规抗心衰治疗,治疗组在常规抗心衰治疗基础上加服左甲状腺素治疗,比较两组治疗效果。治疗组分为两个亚组,一组疗程2周,另一组疗程12周,比较两个亚组治疗效果。结果两组平均住院时间比较,差异有统计学意义(t=3.87,P均<0.05),治疗组住院时间更短;两组患者治疗后左室和血分数(LVEF)、左室舒张末期同内径(LVDD)、心输出量(CO)差异均有统计学意义(t分别=5.82、5.56、6.95;4.29、3.20、2.76,P均<0.05);两组患者治疗后均出现游离三碘原氯酸(FT3)升高及基础代谢率(BMR)下降,差异均有统计学意义(t分别=23.74、16.98;18.39、14.89,P均<0.05),而游离甲状腺素(FT4)及促甲状腺素(TSH)变化均不明显,差异无统计学意义(t分别=1.40、1.33;0.74、1.27,P均>0.05);两亚组患者LVEF变化差异无统计学意义(t=0.68,P>0.05),而FT3及BMR差异有统计学意义(t分别=3.00、2.63,P均<0.05)。结论左甲状腺素替代治疗CHF伴低T3综合征患者有一定疗效,并选择适当疗程。

Effect of L-thyroxine replacement therapy on 56 cases of congestive heart failure with low T3 syndrome

Objective To analyze the change characteristics of thyroid hormone level and observe the therapeutic effect of L-thyroxine in treatment of congestive heart failure（CHF） with low T3 syndrome（ESS）. Methods A total of 56 cases of CHF with ESS were randomly assigned into control group and treatment group.The control group was received routine ant-heart failure treatment and the treatment group was received L-thyroxine based on routine ant-heart failure treatment. The therapeutic effect of two groups was compared. The treatment group was randomly divided into two subgroups,the one course was two weeks,the other was twelve weeks. The therapeutic effect of two subgroups was compared. Results Com- pared to the control group, average length of stay of treatment group was shorter,the difference was statistically significant （t=3.87,P〈0.05）.The level of LVEF,LVDD,CO of two groups were all improved after treatment, the differences were statistically significant （t=5.82,5.56,6.95;4.29,3.20,2.76,P〈0.05）. FT3 in two groups after treatment elevated and BMR decreased （t=23.74,16.98;18.39,14.89,P〈0.05） while the changes of FT4 and TSH had no statistical significance （t=1.40,1.33; 0.74,1.27,P〉0.05）.The two subgroups after treatment had no statistical difference in LVEF （t=0.68,P〉0.05） while the subgroup of long course had a significantly increase in FT3 and BMR （t=3.00,2.63 ,P〈0.05）. Conclusions Patients of CHF with ESS who received L-thyroxine replacement therapy had effect to some extent and should choose course suitably.