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目的探讨心脏疾患及合并充血性心力衰竭(CHF)患儿心衰时,血清甲状腺激素(TH)水平的变化规律及临床意义。方法对2003-09—2006-09山西省阳泉市第一人民医院收治的116例心脏疾病患儿分为2组,心脏病合并CHF组82例,心脏病未合并CHF组34例,以28例健康体检儿童为对照组,均做如下检测及分析:(1)检测CHF患儿血清TH水平,包括三碘甲状腺原氨酸(T3)、游离T3(FT3)、甲状腺素(T4)、游离T4(FT4)、反T3(rT3)及促甲状腺激素(TSH),三组间进行比较。(2)以血清TH水平与心功能进行相关分析。(3)动态观察CHF患儿的血清TH水平,探索其变化规律。结果(1)CHF组与N-CHF组及正常对照组比,血清T3、FT3及FT4均显著降低(P<0.01),rT3显著升高(P<0.01)。(2)随心功能的下降,T3、FT3、T4、FT4渐降低,rT3渐升高。TSH与心功能变化无相关性。(3)CHF组经治疗后血清TH多恢复(P<0.01),顽固性心衰组则无恢复(P>0.05)。结论(1)小儿CHF伴有血清TH的改变,以T3、FT3及FT4的降低,rT3的升高为主,其改变程度与心功能状态具有相关性。(2)随着心功能的改善,TH的改变多渐恢复,顽固性心衰患儿则无恢复,提示TH水平持续不恢复者预后较差。
Objective To investigate the changes and clinical significance of serum thyroid hormone (TH) levels in heart disease and heart failure patients with congestive heart failure (CHF). Methods One hundred and sixty-six children with heart disease admitted to the First People’s Hospital of Yangquan, Shanxi Province from September 2003 to September 2006 were divided into two groups: 82 patients with heart disease complicated with CHF, 34 patients without heart disease with CHF, and 28 patients The healthy children were taken as the control group, all of them were tested and analyzed as follows: (1) Serum TH levels in children with CHF, including T3, FT3, T4, T4 (FT4), anti-T3 (rT3) and thyrotropin (TSH) were compared between the three groups. (2) Correlation analysis between serum TH level and cardiac function. (3) To dynamically observe the level of serum TH in children with CHF, and to explore the change rule. Results (1) Compared with N-CHF group and normal control group, serum T3, FT3 and FT4 in CHF group were significantly decreased (P <0.01) and rT3 was significantly increased (P <0.01). (2) decreased cardiac function, T3, FT3, T4, FT4 gradually decreased, rT3 gradually increased. There was no correlation between TSH and cardiac function. (3) The level of serum TH was recovered in CHF group after treatment (P <0.01), but not in refractory heart failure group (P> 0.05). Conclusions (1) Serum TH is associated with CHF in infants with the decrease of T3, FT3 and FT4, and the increase of rT3, and the degree of change correlates with the state of cardiac function. (2) With the improvement of cardiac function, the change of TH gradually recovered gradually, while the children with refractory heart failure did not recover, suggesting that the prognosis of patients with persistent or non-recovered TH level was poor.