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目的:观察在常规药物治疗基础上加用左旋甲状腺素片对重度心力衰竭扩张型心肌病患者心功能和细胞因子的影响。方法:选取我院住院的重度心力衰竭扩张型心肌病52例。分为(1)对照组25例:给予常规的抗心力衰竭药物治疗;(2)治疗组27例:在常规抗心力衰竭药物治疗基础上伍用左旋甲状腺素片12.5~25μg/d。随访4周。治疗前后采用心脏超声检测左室舒张末期内径(LVd)和左室射血分数(LVEF),用放射免疫法检测FT3、FT4、TSH和外周血清中肿瘤因子α(TNFα)的变化。结果:治疗4周后两组左室射血分数均增加,LVd和TNFα均有不同程度降低。同对照组相比,治疗组FT3显著增加(2.26±0.53 vs 4.83±0.92 pmol/L,P<0.05);LVEF增加更显著(38.4±8.2 vs 31.5±7.6%,P<0.05),TNFα降低更明显(21.638±8.925 vs 30.553±9.735 fmol/mL,P<0.05)。结论:在常规抗心力衰竭治疗的基础上加用小剂量左旋甲状腺素可显著提高重度心力衰竭扩张型心肌病的临床疗效,改善心功能,降低细胞因子水平。
OBJECTIVE: To observe the effects of levothyroxine tablets on cardiac function and cytokines in patients with severe heart failure and dilated cardiomyopathy. Methods: 52 cases of severe cardiomyopathy dilated cardiomyopathy hospitalized in our hospital were selected. Divided into (1) control group of 25 patients: given conventional anti-heart failure drug treatment; (2) treatment group of 27 patients: the routine anti-heart failure drug treatment based on the use of levothyroxine tablets 12.5 ~ 25μg / d. Followed up for 4 weeks. Before and after treatment, left ventricular end-diastolic diameter (LVd) and left ventricular ejection fraction (LVEF) were measured by echocardiography. The levels of tumor necrosis factor α (TNFα) in FT3, FT4, TSH and peripheral blood were measured by radioimmunoassay. Results: After 4 weeks of treatment, left ventricular ejection fraction of both groups increased, while LVd and TNFα decreased. Compared with control group, FT3 in treatment group increased significantly (2.26 ± 0.53 vs 4.83 ± 0.92 pmol / L, P <0.05), LVEF increased more significantly (38.4 ± 8.2 vs 31.5 ± 7.6%, P <0.05) (21.638 ± 8.925 vs 30.553 ± 9.735 fmol / mL, P <0.05). Conclusion: The addition of low-dose levothyroxine can significantly improve the clinical efficacy of dilated cardiomyopathy in severe heart failure, improve cardiac function and decrease the level of cytokines on the basis of routine anti-heart failure treatment.