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目的 探讨小儿充血性心力衰竭 (CHF ,简称心衰 )时血清甲状腺激素水平的变化及意义。方法 用放射免疫法分别测定 62例CHF患儿心衰急性期、恢复期及 3 6例正常对照组血清三碘甲状腺原氨酸 (T3)、四碘甲状腺原氨酸(T4)、促甲状腺激素 (TSH)、反三碘甲状腺原氨酸 (rT3)及T3与rT3的比值 (T3/rT3)。结果 CHF组急性期与对照组比较 :T3明显下降 ,P <0 0 5 ;rT3显著升高、T3/rT3显著下降 ,P均 <0 0 1;T4,TSH无明显改变。对照组与CHF组不同程度心衰患儿比较 :心衰越重 ,T3及T3 rT3下降越显著 ,rT3升高越显著 ,P均 <0 0 1。重度心衰患儿可出现T4显著下降 ,P <0 0 1,轻、中度心衰患儿T4无明显改变。心衰恢复期T3明显上升 ,P <0 0 5 ;rT3显著下降、T3 rT3显著上升 ,P均 <0 0 1。结论 心衰时可出现T3及T3 rT3下降 ,rT3上升 ,T4正常或下降 (重度心衰时 ,T4下降 )。甲状腺激素水平对CHF患儿心衰程度、病情、治疗及预后具有指导意义。
Objective To investigate the changes of serum thyroid hormones in children with congestive heart failure (CHF) and its significance. Methods Totally 62 acute CHF patients with congestive heart failure (CHF) and 36 healthy controls were enrolled in this study. Serum triiodothyronine (T3), thyrotropin (T4), thyrotropin (TSH), anti-triiodothyronine (rT3) and the ratio of T3 to rT3 (T3 / rT3). Results Compared with the control group, the levels of T3 in the CHF group were significantly decreased (P <0.05); the levels of rT3 and T3 / rT3 were significantly decreased in both CHF group (P <0.01); T4 and TSH did not change significantly. Compared with CHF patients of different degrees of heart failure in CHF group, heart failure was more severe, T3 and T3 rT3 decreased more significantly, rT3 increased more significantly, P <0.01. T4 in children with severe heart failure can be significantly decreased, P <0 01, T4 in children with mild and moderate heart failure did not change significantly. Heart failure recovery T3 increased significantly, P <0 05; rT3 decreased significantly, T3 rT3 increased significantly, P <0.01. Conclusions There may be a decrease of rT3 of T3 and T3, a rise of rT3, and a normal or a decrease of T4 in heart failure (T4 declines in severe heart failure). Thyroid hormone levels in CHF children with heart failure severity, disease, treatment and prognosis of the guidance.