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甲状腺是人体内最大的内分泌腺体, 对人体代谢具有重要意义, 正常情况下甲状腺激素(thyroid hormone, TH)水平保持稳定, 在体内保持动态平衡, 当机体心、肺、脑等器官发生严重病变时这种平衡被打破。为此, 我们采用发光免疫分析。探讨了TH在心血管疾病诊断和治疗中的临床应用, 现将结果报道如下。
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(1) TH水平分析: 150例冠心病心力衰竭、86例AMI和103例肺心病患者血清T3、FT3和T3/rT3水平与47名正常者比较明显降低(t=2.120, 2.214, 4.365, P均 < 0.05), 而血清rT3水平明显增高(t= 2.256, 4.416, 4.512, P均 < 0.05)。冠心病心力衰竭患者、AMI患者和肺心病患者血清中甲状腺素、游离甲状腺素和促甲状腺激素与正常对照组比较无明显差异(t=1.781、1.813、1.754, P均 > 0.05)(表 1)。
组别 例数(n) 三碘甲腺原氨酸(pg/ml) 甲状腺素(pg/ml) 游离三碘甲腺原氨酸(pmol/L) 游离甲状腺素(pmol/L) 促甲状腺激素(mIU/L) 反转7磺甲腺原氨酸(ng/ml) 三碘甲腺原氨酸/反转三碘甲腺原氨酸 正常对照组 47 1.35±0.41 84.11±18.70 4.81±1.31 14.61±3.33 2.46±1.39 0.58±0.33 2.61±0.67 冠心病心力衰竭 Ⅰ级 46 1.28±0.30 83.11±16.43 4.48±1.26 14.58±2.89 2.37±1.18 0.68±0.31 1.88±0.61 Ⅱ级 35 1.16±0.28 81.14±17.66 4.00±1.31 14.73±3.01 2.40±1.27 0.88±0.28 1.32±0.58 Ⅲ级 38 1.01±0.33 81.56±18.79 3.83±1.16 14.23±3.13 2.39±1.36 1.05±0.24 0.96±0.55 Ⅳ级 31 0.71±0.35 78.88±18.21 3.46±1.28 14.44±2.56 2.41±1.22 1.21±0.29 0.59±0.37 急性心肌梗死 86 0.68±0.36 80.45±20.11 3.38±1.17 13.98±3.29 2.56±1.28 1.38±0.41 0.49±0.38 肺心病 急发期 36 1.08±0.36 82.18±18.15 3.86±1.08 14.81±3.57 2.49±1.29 0.98±030 1.10±0.48 缓解期 67 1.30±0.32 83.33±20.91 4.56±1.29 13.82±4.00 2.38±1.44 0.71±0.34 1.89±0.59 表 1 冠心病心力衰竭、急性心肌梗死和肺心病患者血清甲状腺激素水平比较(x±s)
(2) 冠心病心力衰竭分级与TH水平: 150例冠心病心力衰竭患者的血清T3、FT3和T3/rT3水平随冠心病心力衰竭的严重程度(Ⅰ~Ⅳ级)的增加而明显降低, AMI患者最低(表 1)。
(3) 肺心病患者TH水平: 103例肺心病患者中, 36例急发期患者较之67例缓解期患者血清T3、FT3和T3/rT3的水平降低越明显(表 1)。
甲状腺激素在心血管疾病诊断和治疗中的临床应用
Clinical application of thyroid hormone in diagnosis and therapy on cardiovascular disease
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摘要:
目的 探讨甲状腺激素在心血管疾病诊断和治疗中的临床应用。 方法 用发光免疫分析法150例冠心病心力衰竭患者,86例急性心肌梗死(AMI)患者,103例肺心病患者和47名我院健康体检者(正常对照组)血清中的甲状腺激素水平。 结果 冠心病心力衰竭患者、AMI患者和肺心病患者血清中三碘甲腺原氨酸(T3)、游离三碘甲腺原氨酸(FT3)及T3/反转三碘甲腺原氨酸(rT3)较正常对照组明显降低(t=2.120、2.214、4.356, P均 < 0.05),而血清rT3明显增高(t=2.256、4.416、4.512,P均 < 0.05)。冠心病心力衰竭患者的血清T3、FT3及T3/rT3随心力衰竭的严重程度明显降低;肺心病急发期较缓解期降低明显,rT3则增加明显。冠心病心力衰竭患者、AMI患者和肺心病患者血清中甲状腺素、游离甲状腺素和促甲状腺激素与正常对照组比较无明显差异(t=1.781、1.813、1.754,P均 > 0.05)。 结论 血清T3、FT3和T3/rT3的降低和rT3的增高是诊断冠心病心力衰竭及严重程度、AMI和肺心病急发期或缓解期的有效指标,并具有治疗后随访的临床价值。 Abstract:Objective To study clinical application of sera thyroid hormone in diagnosis and therapy on cornary heart disease(CHD)heart failure, acute myocardial infarction(AMI)and pulmonary heart disease. Methods Determined the changes of serum triiodothyronine(T3), tetraiodothyronine(T4), free triiodothyronine(FT3), free tetraiodothyronine(FT4), thyroidstimulating hormone(TSH), reverse triiodothyronine(rT3) and T3/ rT3levels in 150 cases patients with CHD heart failure, 86 cases patients with AMI, 103 cases patients with pulmonary heart disease and 47 cases normal controls by chemiluminescent measurement. Results The serum levels of T3, T4, FT3, FT4, TSH, rT3 and T3/rT3in CHD heart failure, AMI pulmonary heart disease were compared with normal controls.Serum T4, FT4 and TSH levels were not different between above patients and normal controls(t=2.120, 2.214, 4.356, P < 0.05), but the serum T3, FT3 and T3/rT3were significantly decreased than those of normal controls(t=2.256, 4.416, 4.512, P < 0.05).The serum rT3levels were significantly increased those of than normal controls(t=1.781, 1.813, 1.754, P > 0.05).The serum T3, FT3 and T3/ rT3levels were significantly decreased in patient with CHD heart failure severity.But the serum rT3levels was significantly increased. Conclusion The present study showed that change of serum T3, FT 3and T3/rT3levels in patients with CHD heart failure, AMI and pulmonary heart disease were inpartant marker and could reflect the severity of disease and used as diagnostic or treatment indicators. -
表 1 冠心病心力衰竭、急性心肌梗死和肺心病患者血清甲状腺激素水平比较(x±s)
组别 例数(n) 三碘甲腺原氨酸(pg/ml) 甲状腺素(pg/ml) 游离三碘甲腺原氨酸(pmol/L) 游离甲状腺素(pmol/L) 促甲状腺激素(mIU/L) 反转7磺甲腺原氨酸(ng/ml) 三碘甲腺原氨酸/反转三碘甲腺原氨酸 正常对照组 47 1.35±0.41 84.11±18.70 4.81±1.31 14.61±3.33 2.46±1.39 0.58±0.33 2.61±0.67 冠心病心力衰竭 Ⅰ级 46 1.28±0.30 83.11±16.43 4.48±1.26 14.58±2.89 2.37±1.18 0.68±0.31 1.88±0.61 Ⅱ级 35 1.16±0.28 81.14±17.66 4.00±1.31 14.73±3.01 2.40±1.27 0.88±0.28 1.32±0.58 Ⅲ级 38 1.01±0.33 81.56±18.79 3.83±1.16 14.23±3.13 2.39±1.36 1.05±0.24 0.96±0.55 Ⅳ级 31 0.71±0.35 78.88±18.21 3.46±1.28 14.44±2.56 2.41±1.22 1.21±0.29 0.59±0.37 急性心肌梗死 86 0.68±0.36 80.45±20.11 3.38±1.17 13.98±3.29 2.56±1.28 1.38±0.41 0.49±0.38 肺心病 急发期 36 1.08±0.36 82.18±18.15 3.86±1.08 14.81±3.57 2.49±1.29 0.98±030 1.10±0.48 缓解期 67 1.30±0.32 83.33±20.91 4.56±1.29 13.82±4.00 2.38±1.44 0.71±0.34 1.89±0.59 -
[1] Opasich C, Pacini F, Ambrosino N, et al. Sick euthyroid syndrome in patients with moderate-to-severe chronic heart failure. Eur Heart J, 1996, 17(12): 1860-1866. doi: 10.1093/oxfordjournals.eurheartj.a014804 [2] 杜馥曼, 刘彤梅, 王嵬民. 血清甲状腺激素水平与心力衰竭关系分析. 放射免疫学杂志, 2006, 19(3): 205-206. doi: 10.3969/j.issn.1008-9810.2006.03.028
[3] Hamilton MA, Stevenson LW, Fonarow GC, et al. Safety and hemodynamic effects of intravenous triiodothyronine in advanced congestive heartfailure. Am J Cardiol, 1998, 81(4): 443-447. doi: 10.1016/S0002-9149(97)00950-8 [4] Chodosh S. Clinical significance of the infection-free interval in the management of acute bacterial exacerbations of chronic bronchitis. Chest, 2005, 127(6): 2231-2236. doi: 10.1378/chest.127.6.2231 [5] 毛庆民, 毛鑫, 张新庆. 血清甲状腺激素检测在肺心病患者诊断和治疗中的应用. 放射免疫学杂志, 2008, 21(2): 140.