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目的观察碘对比剂对低T_3综合征(LT_3S)经皮冠状动脉介入(PCI)术后甲状腺功能的短期影响。方法选择2014年1月至2016年9月滁州市第一人民医院心内科收治的接受PCI治疗的冠心病患者60例,依据甲状腺激素水平分为LT_3S组(30例)和甲状腺功能正常组(30例)。所有患者于冠状动脉造影及PCI术中均使用碘克沙醇320作为造影剂。分别于PCI术前及术后1个月采用放射免疫法(RIA)测定游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT4)、三碘甲状腺原氨酸总量(TT_3)、甲状腺素总量(TT_4)和促甲状腺激素(TSH)水平并进行比较。结果两组术前TSH、FT_4和TT_4水平比较无统计学差异(P均>0.05);术前LT_3S组FT_3、TT_3水平低于甲状腺功能正常组(P<0.05,P<0.01);两组术后TSH、FT_3、TT_3水平比较有统计学差异(P<0.05,P<0.01)。LT_3S组术后TSH水平较术前明显上升,FT_3和TT_3水平较术前显著降低(P均<0.05)。甲状腺功能正常组PCI手术前后甲状腺激素水平无明显变化(P>0.05)。结论碘对比剂可能进一步损害LT_3S合并冠心病患者的甲状腺功能。
Objective To observe the short-term effect of iodine contrast agent on thyroid function after percutaneous coronary intervention (PCI) in patients with low T 3 syndrome (LT 3S). Methods Sixty patients with coronary artery disease undergoing PCI from January 2014 to September 2016 in Department of Cardiology, Chuzhou First People’s Hospital were divided into three groups according to the level of thyroid hormone: LT_3S group (30 cases) and thyroid function group (30 cases) example). All patients used iodixanol 320 as a contrast agent in coronary angiography and PCI. The levels of free triiodothyronine (FT_3), free thyroxine (FT4), total triiodothyronine (TT_3) and thyroid were measured by radioimmunoassay (RIA) Total amount of total (TT_4) and thyroid stimulating hormone (TSH) levels and compared. Results There was no significant difference in preoperative levels of TSH, FT_4 and TT_4 between the two groups (all P> 0.05). The levels of FT_3 and TT_3 in LT_3S group before operation were lower than those in normal thyroid function group (P <0.05, P <0.01) After TSH, FT_3, TT_3 levels were statistically significant difference (P <0.05, P <0.01). The level of TSH in LT_3S group was significantly higher than that before operation, the levels of FT_3 and TT_3 were significantly lower than those before operation (all P <0.05). Thyroid hormone levels did not change significantly before and after PCI in patients with normal thyroid function (P> 0.05). Conclusion Iodine contrast agents may further impair thyroid function in patients with LT_3S and coronary heart disease.