甲狀腺激素測定在高血壓心力衰竭患者中的臨床意義

楊錦龍　劉歡

摘 要：目的 探討高血壓合并心力衰竭患者體內的甲狀腺激素水平變化情況及其臨床意義。方法 選擇2016年3月～2018年3月收住我院的原發性高血壓患者共173例，根據患者是否合并心功能衰竭分為心衰組123例和對照組50例。心衰組患者按NYHA心功能分級標準進行分級，心功能Ⅱ級40例，Ⅲ級48例，Ⅳ級35例。心衰組患者常規予降壓及抗心衰治療，對照組患者僅予降壓治療，觀察對比兩組患者的甲狀腺激素水平、B型利鈉肽前體、射血分數水平等指標。比較各組間臨床資料，采用Pearson相關性分析甲狀腺激素水平與BNP、LVEF的關系。結果 心衰組患者的TT3、FT3、LVEF均低于對照組，差異具有統計學意義（P<0.05），心衰組與對照組TT4、FT4、TSH比較，差異無統計學意義（P>0.05）。隨心衰組患者心功能分級的加重，TT3、FT3、LVEF水平呈依次下降趨勢，BNP升高，差異有統計學意義（P<0.05）。BNP與TT3、FT3、LVEF呈負相關（r=-0.508、-0.251、-0.283，P<0.01），LVEF與TT3呈正相關（r=0.658，P<0.01）。結論 高血壓心力衰竭患者常伴有甲狀腺激素代謝紊亂，其中TT3、FT3水平在一定程度上能反映心力衰竭嚴重程度。

關鍵詞：高血壓；甲狀腺激素；心力衰竭；正常甲狀腺功能病態綜合征

中圖分類號：R541.6；R544.1；R446.11 文獻標識碼：A DOI：10.3969/j.issn.1006-1959.2018.22.026

文章編號：1006-1959（2018）22-0096-04

Clinical Signifcance of Changes of Serum Thyroid Hormone Levels in Hypertensive

Patients with Chronic Heart Failure

YANG Jin-long1，LIU Huan2

（Department of Cardiology1，Department of Endocrinology2，People's Hospital of Leshan，Leshan 614000，Sichuan，China）

Abstract：Objective To investigate the change and clinical signifcance of serum thyroid hormone levels in hypertensive patients with chronic heart failure.Methods A total of 173 patients with essential hypertension admitted to our hospital from March 2016 to March 2018 were enrolled. According to whether the patients with heart failure were divided into heart failure group （123 cases） and control group （50 cases）. Patients with heart failure were graded according to NYHA cardiac function grading criteria. 40 patients with grade II cardiac function， 48 patients with grade III， and 35 patients with grade IV. Patients in the heart failure group were treated with antihypertensive and anti-heart failure. The patients in the control group were treated with antihypertensive therapy. The thyroid hormone levels， B-type natriuretic peptide precursors， and ejection fraction levels were compared between the two groups. The clinical data of each group were compared， and the relationship between thyroid hormone levels and BNP and LVEF was analyzed by Pearson correlation.Results The TT3， FT3 and LVEF of the patients with heart failure were lower than those of the control group， the difference was statistically significant （P<0.05）. There was no significant difference between the heart failure group and the control group TT4， FT4 and TSH （P>0.05）. The heart function grading of patients with heart failure group increased， TT3， FT3， LVEF levels decreased in turn， BNP increased， the difference was statistically significant （P<0.05）. BNP was negatively correlated with TT3， FT3 and LVEF （r=-0.508，-0.251，-0.283， P<0.01）， and LVEF was positively correlated with TT3 （r=0.658， P<0.01）. Conclusion Hypertensive heart failure patients are often accompanied by thyroid hormone metabolism disorders， and the levels of TT3 and FT3 can reflect the severity of heart failure to a certain extent.

Key words：Hypertensive；Thyroid hormone；Heart failure；Normal thyroid dysfunction syndrome

隨著我國社會老齡化進程的加速，高血壓的發病率逐年增加，即使對高血壓的良好控制，很多患者數年后逐漸發生心力衰竭。心力衰竭（chronic heart failure）是大多數高血壓患者發展的終末階段，也是其主要死亡原因。甲狀腺激素水平在一定程度上對人體各個器官組織的內分泌代謝產生影響，其中與心衰密切相關[1]。心衰時常出現正常甲狀腺功能病態綜合征（euthyroid sick syndrome，ESS），ESS是由于嚴重的急慢性疾病、手術等原因引起的非甲狀腺疾患所致的甲狀腺功能性異常，包括低T3綜合征、低T3低T4綜合征及其他異常，而促甲狀腺激素正常，且臨床上沒有甲狀腺功能減退的表現[2]。……