内源性亚临床甲状腺功能亢进症需要治疗吗? 被引量：1

Endogenous subclinical hyperthyroidism: needs it to be intervened?

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摘要目的研究亚临床甲亢(SH)对心脏和骨骼的影响及治疗选择.方法 43例内源性SH患者按TSH水平分为A组(21例,TSH轻度降低,0.03～0.60 mIU/L)和B组(22例,TSH显著降低,＜0.03 mIU/L).应用多普勒超声心动仪检测心脏结构和功能;Holter心率变异(HRV)时域指标评估心脏自主神经调节;双能X线吸收仪测定第2～4腰椎(L2-4)、股骨近端骨密度(BMD).对临床甲亢患者和正常对照者进行同样的检测.随访观察SH患者的转归.结果 SH两组左心室后壁厚度(LVPW)、左心室舒张末内径(LVDd)、左心室射血分数(LVEF)的差异均无统计学意义,但B组反映心脏舒张功能的等容舒张时间(IVRT)延长,E/A下降(均P＜0.05).HRV参数显示,正常窦性心搏间期标准差(SDNN)、窦性心博间期之差的均方根(rMSSD)、正常窦性心搏间期的变异系数(CV)和相邻正常窦性心搏间期≥50 ms的心搏数占总的正常窦性心搏间期个数的百分数(PNN50)在两组均下降(A组均P＜0.05;B组均P＜0.01).A组SDNN和PNN50与TSH变化呈正相关(r1=0.56,r2=0.61,均P＜0.01).以上结果显示SH患者早期心脏迷走神经受损.绝经后女性SH患者的B组BMD下降(P＜0.05),有明显骨量丢失.随访中B组房颤、临床甲亢发生率高(与A组比较,均P＜0.01).结论对TSH显著降低的SH患者,有必要早期干预治疗. Objective To explore the effects of subclinical hyperthyroidism (SH) on heart and bone and the optionof treatment. Methods Forty-three patients with endogenous SH were divided into two groups by the TSH level: group A (21 cases,TSH 0.03-0.60 mIU/L) and group B (22 cases, TSH<0.03 mIU/L). The structure and function of heart were quantified by Doppler-echocardiography; Holter heart rate variability (HRV) was performed to evaluate the cardiac automomic regulation; Dual energy X-ray absorptiometry was applied to detect the bone mineral density (BMD) at L_ 2-4 and proximal end of femur. Cases with overt hyperthyroidism and subjects of normal control were investigated with the same parameters. The outcome of SH patients was followed. Results Doppler echocardiography revealed that LVPW、LVDd and LVEF showed no significant difference between in group A and group B,whereas IVRT was significantly prolonged and E/A value was significantly decreased in group B (both P<0.05). HRV parameters showed that SDNN, rMSSD,CV and PNN_ 50 were significantly decreased in group A (all P<0.05) and group B (all P<0.01); In group A, SDNN and PNN_ 50 was positively correlated with the level of TSH (r_ 1=0.56, r_ 2=0.61, both P<0.01). Above results showed that the impaired parasympathetic control of heart did exist early in patients with SH. BMD in postmenopausal women was significantly decreased in group B (P<0.05). During follow-up, the occurences of atrial fibrillation and overt hyperthyroidism were higher in group B than in guoup A (all P<0.01). Conclusion Early antithyroid therapy should be considered in patients with endogenous subclinical hyperthyroidism with obviously suppressed TSH level.

作者施亚雄郑善德李永加陶耕

机构地区福建医科大学附属第二医院内分泌科

出处《中华内分泌代谢杂志》 CAS CSCD 北大核心 2005年第2期176-179,共4页 Chinese Journal of Endocrinology and Metabolism

关键词内源性亚临床甲状腺功能亢进症心脏功能骨骼骨密度心电图 Hyperthyroidism, subclinical Echocardiography, Doppler Heart rate variability Bone density

分类号 R581.1 [医药卫生—内分泌]

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