摘要
目的 :探讨血清三碘甲状腺原氨酸 (T3)、甲状腺素 (T4)水平与急性心肌梗死 (AMI)患者预后及其左室功能的关系。方法 :42例 AMI患者 ,发病 72小时内检测总 T3(TT3)、总 T4(TT4)、游离 T3(FT3)、游离 T4(FT4)及促甲状腺激素 (TSH) ,此后 ,每周监测 1次 ,连续 4周。发病 4～ 5周内 ,彩色多普勒测定左室功能。观察好转组与预后不良组血清 T3、T4的差异及其对左室功能的影响。同时检测 30例陈旧性心肌梗死 (OMI)患者TT3、TT4、FT3、FT4及 TSH进行对照观察。结果 :AMI早期好转组患者血清 TT3(0 .79± 0 .2 8) nmol/ L、TT4(5 7.13± 18.42 ) nmol/ L、FT3(3.32± 0 .89) pmol/ L ,预后不良组患者血清 TT3(0 .5 8± 0 .2 5 ) nmol/ L、TT4(4 6 .2 5± 17.5 6 ) nmol/ L、FT3(3.11± 0 .78) pmol/ L ,均有不同程度的降低 ,好转组与预后不良组间无显著差异(P>0 .0 5 )。 FT4好转组为 (15 .6 6± 5 .49) pm ol/ L,预后不良组为 (13.96± 6 .0 5 ) pm ol/ L,TSH好转组为 (4 .37± 2 .5 2 ) m U/ L,预后不良组为 (2 .5 6± 2 .19) m U/ L,均正常。病程第 4周末预后不良组及好转组血清 TT3、TT4、FT3 分别为 (1.11± 0 .2 8) nmol/ L、(5 7.2 5± 18.5 6 ) nmol/ L、(3.41± 0 .79) pm ol/ L 及 (2 .33± 0 .32 )
Objective:To study the relationship between serum triiodothyronine(T 3),tetraiodothyronine(T 4) levels and left ventricular function in patient with acute myocardial infarction(AMI),thereby assessing the prognostic values of T 3 and T 4 in AMI.Methods:Using radioimmunoassay,serum total T 3(TT 3),total T 4(TT 4),free T 3(FT 3),free T 4(FT 4),and thyroidstimulating hormone(TSH) were determined within 72 hours and at 1,2,3,4 weeks after AMI in 42 patients.Left ventricular function was monitored by colour Doppler between 4 and 5 weeks after AMI.Thirty patients with old myocardial infarction(OMI) were used as control.Results:Serum TT 3,TT 4 and FT 3 were(0 79±0 28)nmol/L,(57 13±18 42)nmol/L,(3 32± 0 89)pmol/L ,respectively,in the early improvement group (group A),but when these parameters reached (0 58± 0 25)nmol/L ,(46 25±17 56)nmol/L,(3 11±0 78)pmol/L,respectively,recovery was unfavourable (group B) in the early phase in patients with AMI.NO significant differences were observed in the two groups ( P >0 05).FT 4 and TSH were normal in both groups A and B.TT 3,TT 4 and FT 3 were(1 11± 0 28)nmol/L ,(57 25±18 56)nmol/L,(3 41±0 79)pmol/L,respectively, in the group B and (2 33± 0 32)nmol/L ,(82 34±24 83)nmol/L,(6 01±1 16)pmol/L in the group A at the end of 4 weeks after AMI.The level of all the parameters were significantly lower in group B than those in group A (all P <0 05).Serum TT 3,TT 4,FT 3 and FT 4 were almost normal in the OMI patients and significantly higher than those in the AMI group ( P <0 05).Left atrial dimension(LAD),left ventricular end diastolic dimension(LVDd),left ventricular endsystolic dimension(LVDs) and ejection fraction(EF) were (35 3±4 1)mm,(54 9±4 7)mm,(36 1±3 1)mm,0 44±0 04,respectively,in the group B and (30 2±2 8)mm,(47 2±3 9)mm,(30 4±2 7)mm,0 55±0 04 in the group A.Significant differences were observed in each parameters between the two groups.There was a negative correlation between the incidence of postinfarctional angina pectoris or reinfarction after AMI and EF,TT 3 (standardized partial regression coefficient was -0 728,-0 831,both P <0 001).There was a negative correlation between TT 3 and LAD,LVDd,LVDs( r =-0 865,-0 843 and -0 871).There was a positive correlation between TT 3 and EF ( r =0 911, P <0 001).Conclusions:Monitoring thyroid hormone levels are of importance in the prediction of prognosis and left ventricular function in patient with AMI.
出处
《中国危重病急救医学》
CAS
CSCD
2000年第11期653-656,共4页
Chinese Critical Care Medicine
基金
兰州军区医药卫生科研计划基金资助项目!(No.L XH9917)
关键词
心肌梗死
急性
左心室功能
甲状腺功能
triiodothyronine
tetraiodothyronine
thyroidstimulating hormone
acute myocardial infarction
prognosis
left ventricular function
