老年慢性心力衰竭患者的正常甲状腺功能病态综合征

目的　探讨老年慢性心力衰竭患者中正常甲状腺功能病态综合征的情况及其与老年人病情和预后的关系。方法　运用化学发光免疫法测定老年慢性心力衰竭患者 (6 6例 )及对照组 (30例 )血浆三碘甲状腺原氨酸 (T3 )、甲状腺素 (T4)、游离三碘甲状腺原氨酸 (FT3 )、游离甲状腺素 (FT4)及促甲状腺素 (TSH)水平。结果　心力衰竭患者与对照组比较 ,T3 、FT3 明显降低 ,心力衰竭越重 ,降低越明显。心功能分级标准Ⅳ级患者T4、FT4及TSH较对照组降低明显 ,T4、FT4降低或合并TSH降低者 ,病死率高。结论　老年慢性心力衰竭患者常伴有正常甲状腺功能病态综合征 ,尤其是正常甲状腺功能病态综合征中低T3 低T4综合征为预后不良指标。甲状腺激素有望成为心力衰竭治疗中的一类新型药物。

Euthyroid sick syndrome in the elderly with congestive heart failure

Objective To study the occurrence of euthyroid sick syndrome (ESS) and the relationship between prognosis of congestive heart failure (CHF)and ESS in the elderly with CHF.Methods Triiodothyronine (T 3),thyroxine (T 4),free triiodothyronine (FT 3),free thyroxine (FT 4) and thyroid-stimulating hormone(TSH) were determined by chemiluminescence immunoassay in the elderly with CHF (n=66) and the healthy subjects(n=30,control group) respectively.Results The levels of T 3 and FT 3 decreased significantly in the elderly with CHF as compared with the control group,and the worse the cardiac function,the more the decrease in the levels of T 3 and FT 3.In patients with cardiac function of class Ⅳ,the levels of T 4,FT 4 and TSH decreased significantly,and when the levels of T 4 and FT 4 decreased or the reduction of the level of TSH occurred simultaneously,the fatality rate was very high.Conclusions ESS occurs commonly in the elderly with CHF,and ESS,especially low T 3～T 4 syndrome,serves as an indication of poor prognosis of CHF.Thyroid hormone is expected to be a new drug for treatment of CHF and is worthwhile for further research.