目的：探讨左旋甲状腺素应用于慢性充血性心力衰竭（CHF）伴低 T3综合征的有效性及安全性。方法选取2011年6月—2013年12月在珠海市第二人民医院心内科确诊并住院的 CHF 伴低 T3综合征患者132例，随机分为对照组（58例）和治疗组（74例）。对照组患者采用常规抗心力衰竭治疗，治疗组患者在常规抗心力衰竭治疗基础上加用左旋甲状腺素，4周为1个疗程，两组患者均治疗4个疗程。比较两组患者治疗前后甲状腺功能指标〔血清三碘甲状腺原氨酸（ T3）、甲状腺素（ T4）、游离三碘甲状腺原氨酸（ FT3）、游离甲状腺素（ FT4）、促甲状腺激素（TSH）水平〕及心功能指标〔左心室舒张末期内径（LVDD）、左心室射血分数（LVEF）、心输出量（CO）、左心室舒张早期充盈峰值流速/舒张晚期充盈峰值流速（E/ A）比值及血清脑钠肽（BNP）水平〕，并观察治疗期间不良反应情况。结果两组患者治疗前血清 T3、T4、FT3、FT4水平及治疗前后血清 TSH 水平比较，差异均无统计学意义（P >0.05）；治疗组患者治疗后血清 T3、T4、FT3、FT4水平高于对照组（P <0.05）。治疗前两组患者 LVDD、LVEF、CO、E/ A 比值及血清 BNP 水平比较，差异无统计学意义（P >0.05）；治疗后治疗组患者 LVDD 和血清 BNP 水平低于对照组，LVEF、CO 和 E/ A 比值高于对照组（P <0.05）。治疗期间两组患者均未发生血栓栓塞现象及其他明显不良反应。结论左旋甲状腺素能有效改善 CHF 伴低 T3综合征患者甲状腺功能及心功能，且无明显不良反应，有效性及安全性均较高。%Objective To investigate the effectiveness and safety of levothyroxine on chronic congestive heart failure complicated with low T3 syndrome. Methods From June 2011 to December 2013,a total of 132 chronic congestive heart failure patients complicated with low T3 syndrome were selected in the Department of Cardiology,the Second People' s Hospital of Zhuhai,and they were randomly divided into control group(n = 58)and treatment group(n = 74). Patients of control group were treated with conventional anti - heart failure medication,while patients of treatment group were given extra levothyroxine based on conventional anti - heart failure medication,4 weeks as a course;both groups treated for 4 courses. Thyroid function index(including serum levels of T3 ,T4 ,FT3 ,FT4 and TSH)and cardiac function index(including LVDD,LVEF,CO,E/A ratio and serum BNP level)were compared between the two groups,and the incidence of adverse reactions during treatment was observed. Results No statistically significant differences of serum levels of T3 ,T4 ,FT3 ,FT4 or TSH was found between the two groups before treatment( P > 0. 05);after treatment,serum levels of T3 ,T4 ,FT3 and FT4 of treatment group were statistically significantly higher than those of control group(P < 0. 05),while no statistically significant difference of serum TSH level was found between the two groups(P > 0. 05). No statistically significant differences of LVDD,LVEF,CO,E/ A ratio or serum BNP level was found between the two groups before treatment(P > 0. 05);after treatment,LVDD and serum BNP level of treatment group were statistically significantly lower than those of control group,while LVEF,CO and E/ A ratio of treatment group were statistically significantly higher than those of control group( P < 0. 05 ). No one of the two groups occurred thromboembolism or other obvious adverse reactions during treatment. Conclusion Levothyroxine have good effectiveness and high safety in treating chronic congestive heart failure complicated with low T3 syndrome,can effectively improve the thyroid function and cardiac function without significant adverse reactions.
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