长期左旋甲状腺素抑制治疗对分化型甲状腺癌患者心功能的影响

摘要

目的 观察长期左旋甲状腺素抑制治疗对分化型甲状腺癌(DTC)患者心功能的影响.方法 选择2010年1月至2014年1月在江门市中心医院普通外科一区住院的行甲状腺双侧腺叶全切术或近全切除术术后的DTC患者(治疗组)33例和体检中心体检的健康者(对照组)35例.治疗组给予左旋甲状腺素片治疗.观察2组心功能指标[基础、终点左心室射血分数(LVEF),基础、终点左心室舒张末期直径(LVDd)]、超声心动图(UCG)提示有无二尖瓣反流和有无心电图异常、有无心血管系统症状及血清TSH水平的变化.结果 2组终点LVEF值和UCG提示无二尖瓣反流、无心电图异常、心血管系统症状(有、无)所占比例比较差异均无统计学意义(均P>0.05).与同组基础LVEF比较,治疗组终点LVEF值明显降低(P<0.05);与同组基础LVDd比较,治疗组终点LVDd值明显升高(P<0.05).与对照组比较,治疗组终点LVDd值明显升高、血清TSH水平明显降低(均P<0.05);治疗组UCG提示有二尖瓣反流、有心电图异常所占比例与对照组比较差异均有统计学意义(均P<0.05).结论 长期左旋甲状腺素抑制治疗会对DTC患者的心血管系统及心功能造成一定的影响.在治疗过程中需密切随访,以减少不良事件的发生.%Objective To investigate the influence of long-term suppressive levothyroxine ther-apy on cardiac function in patients with differentiated thyroid carcinoma(DTC).Methods Thirty-three DTC patients(treatment group)were treated with levothyroxine tablets after total or almost total thyroidectomy in Jiangmen Central Hospital from January 2010 to January 2014.In addition, 35 healthy subjects were selected as the control group.Baseline left ventricular ejection fraction (LVEF),endpoint LVEF,baseline left ventricular end-diastolic diameter (LVDd),endpoint LVDd,ultrasonic cardiography(UCG)for mitral regurgitation and electrocardiographic abnormal-ity,cardiovascular symptoms,and serum thyroid stimulating hormone(TSH)levels were observed in both groups.Results There were no significant differences between the two groups in endpoint LVEF and proportions of patients without mitral regurgitation,electrocardiographic abnormalityand cardiovascular symptoms(P >0.05).Compared with baseline LVEF and LVDd,the endpoint LVEF and LVDd decreased in treatment group(P <0.05).Compared with control group,the end-point LVDd increased and serum TSH levels reduced in treatment group(P < 0.05).Further-more,the proportions of patients with mitral regurgitation and electrocardiographic abnormality were significantly different between the two groups(P <0.05).Conclusion Long-term suppres-sive levothyroxine therapy has adverse effects on cardiovascular system and cardiac function. Therefore,patients should be closely followed up to prevent the adverse cardiovascular events.