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| 慢性心力衰竭合并低T3综合征患者碘甲腺氨酸钠（T3）替代治疗的急性效应：一项随机、安慰剂对照研究 |
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| Acute Effects of Triiodothyronine (T3) Replacement Therapy in Patients with Chronic Heart Failure and Low-T3 Syndrome: A Randomized, Placebo-Controlled Study |
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| Pingitore A, Galli E, Barison A 2009/5/27 10:49:52 |
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| J Clin Endocrinol Metab, 2008, |
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| View at Publisher |
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Abstract
Context:
Low-T3 syndrome is a predictor of poor outcome in patients with cardiac dysfunction. The study aimed to assess the short-term effects of synthetic l-T3 replacement therapy in patients with low-T3 syndrome and ischemic or nonischemic dilated cardiomyopathy (DC).
Design:
A total of 20 clinically stable patients with ischemic (n=12) or nonischemic (n=8) DC were enrolled. There were 10 patients (average age 72yr, range 66–77; median, 25–75th percentile) who underwent 3-d synthetic l-T3 infusion (study group); the other 10 patients (average age 68yr, range 64–71) underwent placebo infusion (control group). Clinical examination, electrocardiography, cardiac magnetic resonance, and bio-humoral profile (free thyroid hormones, TSH, plasma renin activity, aldosterone, noradrenaline, N-terminal-pro-B-Type natriuretic peptide, and IL-6) were assessed at baseline and after 3-d synthetic l-T3 (initial dose: 20μg/m2 body surface·d) or placebo infusion.
Results:
After T3 administration, free T3 concentrations increased until reaching a plateau at 24–48h (3.43, 3.20–3.84 vs. 1.74, 1.62–1.93pg/ml; P=0.03) without side effects. Heart rate decreased significantly after T3 infusion (63, 60–66 vs. 69, 60–76 beats per minute; P=0.008). Plasma noradrenaline (347; 270–740 vs. 717, 413–808pg/ml; P=0.009), N-terminal pro-B-Type natriuretic peptide (3000, 438-4005 vs. 3940, 528-5628pg/ml; P=0.02), and aldosterone (175, 152–229 vs. 231, 154–324pg/ml; P=0.047) significantly decreased after T3 administration. Neurohormonal profile did not change after placebo infusion in the control group. After synthetic l-T3 administration, left-ventricular end-diastolic volume (142, 132–161 vs. 133, 114–158ml/m2 body surface; P=0.02) and stroke volume (40, 34–44 vs. 35, 28–39ml/m2 body surface; P=0.01) increased, whereas external and intracardiac workload did not change.
Conclusions:
In DC patients, short-term synthetic l-T3 replacement therapy significantly improved neuroendocrine profile and ventricular performance. These data encourage further controlled trials with more patients and longer periods of synthetic l-T3 administration.
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 疾病资源中心
病例分析 [栏目介绍]
王燕燕 王曙
上海交通大学附属瑞金医院内分泌科
患者，女，69岁。2009年1月无明显诱因下出现乏力，当时程度较轻，未予以重视。2009年3月患者乏力症状加重，尿色逐渐加深，大便习惯改变，颜色变淡。4月18日入我院感染科治疗，诉轻度头晕、心慌，体重减轻10kg。无肝区疼痛，无发热，无腹痛、腹泻、腹胀、里急后重，无恶性、呕吐等。入院半月前于外院就诊，查肝功能：ALT 601IU/L，AST 785IU/L，TBIL 97.7umol/L，白蛋白 41g/L，甲状腺功能：游离T3 30.6pmol/L，游离T4 51.9pmol/L，心电图示快速房颤。
医学数据库
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