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: NYHA Ⅱ group (25 patients), NYHA Ⅲ group (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 NYHAⅡ group 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 NYHA Ⅲ group, 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.