老年慢性心力衰竭患者甲状腺激素的变化及其临床意义

摘要

目的：探讨老年慢性心力衰竭患者甲状腺激素的变化及其临床意义。方法收集老年慢性心力衰竭76例，其中心功能Ⅱ级25例，Ⅲ级28例，Ⅳ级23例，并选择30例非心力衰竭老年体检者作为对照组，以放射免疫法检测血浆总三碘甲状腺氨酸（ T3）、总甲状腺素（ T4）、游离三碘甲状腺氨酸（ FT3）、游离甲状腺素（ FT4）、促甲状腺素（ TSH）。结果心功能Ⅱ级组T3[（1．28±0．51） nmol/L]和FT3[（3．01±0．78） pmol/L]与对照组[分别为（2．34±0．52） nmol/L 和（4．27±0．64） pmol/L]比较，明显降低（均P＜0．05），且随着心功能分级增加，心功能Ⅲ级、Ⅳ级T3和FT3水平则进一步降低（P＜0．01），心功能Ⅲ级T3和FT3分别为（0．87±0．43）nmol/L和（2．42±0．61）pmol/L，心功能Ⅳ级T3和FT3分别为（0．60±0．36）nmol/L和（2．09±0．71）pmol/L。结论 T3和FT3作为重要的内分泌激素，参与心力衰竭的病理生理进程，可作为老年慢性心力衰竭患者早期临床诊断标志物。%Objective To investigate the changes and clinical significance of thyroid hormones function in elderly patients with chronic heart failure.Methods A total of 76 elderly patients with chronic heart failure were divided into different groups according to NYHA categorization:NYHAⅡgroup (25 patients), NYHAⅢgroup (28 patients) and NYHA IV group (23 patients).Thirty non-heart failure elderly subjects served as control group.T3 , T4 , FT4 , FT3 , TSH were tested by radioimmunoassay.Results Compared with T3 and FT3 levels [(2.34 ±0.52)nmol/L and (4.27 ±0.64) pmol/L respectively] in control group, T3 and FT3 levels[(1.28 ±0.51) nmol/L and (3.01 ±0.78) pmol/L respectively] in NYHAⅡgroup were decreased (P<0.05);and with the deterioration of cardiac function functional class Ⅲ-Ⅳ (P<0.01), patients showed T3 and FT3 levels [ (0.87 ±0.43) nmol/L and (2.42 ± 0.61) pmol/L respectively] in NYHAⅢgroup, and [ (0.60 ±0.36) nmol/L and (2.09 ±0.71) pmol/L respectively ] in NYHA IV group.Conclusions T3 and FT3 play an important role in chronic heart failure, can serve as the early predictors in elderly patients with chronic heart failure.