【作者】 金国栋；

【导师】 徐耕；

【作者基本信息】 浙江大学 ， 内科学， 2003， 硕士

【摘要】 心房颤动(AF)是甲状腺功能失调的常见临床表现，其在不同人群中发生率为5～15％，尤其在年龄大于60岁的老年人中比年轻人发病率更高。当前我国老龄人口日益增多，心房颤动的发病率随年龄而明显增加，容易引起动脉栓塞、脑卒中和充血性心力衰竭等严重并发症。因此，寻找能预测心房颤动发生的指标具有重要的临床意义。促甲状腺激素(TSH)水平降低是判断甲状腺功能损害的早期指标。多年来随着TSH监测水平敏感性的提高，导致发现了许多单纯TSH水平降低而甲状腺素包括游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)正常的老年人且无明显甲状腺功能亢进的临床症状，被定义为亚临床甲状腺功能亢进症。在不同的人群中发病率为0.2～11.8％，与年龄、性别有关。近年来西方流行病学研究发现亚临床甲状腺功能亢进症是老年人心房颤动的独立危险因子，目前国内尚无相关文献报道。本研究检测了心房颤动患者的甲状腺功能指标，旨在探讨中国人群中心房颤动和亚临床甲状腺功能亢进的关系，并且评价在不同年龄段甲状腺功能指标对心房颤动中的预测价值。——1．目 的 探讨中国人群中心房颤动和亚临床甲状腺功能亢进的关系，并且评价在不同年龄段甲状腺功能指标对心房颤动中的预测价值。2．材料与方法：2＊研究对象 曾在本院心内科住院的心房颤动患者95例和对照组139例，分为40～59岁、60～79岁两个年龄段。所有研究对象均经心电图 12导联检查证实，取血前 1个月内未用过胺碘酮等影响甲状腺代谢的药物。排除标准为风湿性心脏病，高血压病，冠状动脉粥样硬化性心脏病，先天性心脏病，扩张型心肌病，病态窦房结综合症等心房颤动常见病因。同时根据甲状腺功能指标的测定把心房颤动患者分为①正常组：TSH、FT3和 FT4水平均正常②甲状腺功能亢进组：TSH水平降低，FT3和 FT4水平升高③亚临床甲状腺功能亢进组：TSH水平降低，FT3和 FT4正常。2．2方法入选者于清晨空腹静脉取血 2 ml，采用免疫化学发光法（ICMA）分别测定血清中的三碘甲状腺原氨酸（T3）、甲状腺激素（T4）、游离三碘甲状腺原氨酸（FT3）。游离甲状腺激素（FT4X促甲状腺激素（TSH）水平（德国Bayer公司的Acs 80E化学发光分析仪）。试剂盒由德国Bayer公司提供。2．3统计实验数据采用 SPSS 10刀协 Windows统计软件包分析。计量资料以均数士标准差表示，组间比较采用配对t检验。计数资料组间比较采用四格表Xz或确切概率法检验，以P＜0刀5为统计学差异有显著性。3．结果：1、不同年龄段甲状腺功能指标与心房颤动的关系，40—59岁年龄段心房颤动组与对照组FT3水平分别为（4＊8士1．26）pmol／L和（3．sltl＊8）pmol／L，前者显著高于后者（P—0＊16），FT4水平分别为（17．74士4．36）pmol几和（I6．26士3．59）pmol／L，前者显著高于后者o二0．025人而TSH、T4、T3水平两组间差异均无 3＊＊＊3．个7 金国栋 2003年浙江大学硕士学位论文 Jin Guo Dong dissertation for M·M·显著性。60—79岁年龄段患者组与对照组TSH水平分别为（l．62土l．38）mIU／U／L和（2．35土1．29）InIU／L，前者显著低于后者（P二0．006），而T3、T4、FT3、FT4水平两组间差异均无显著性。二、心房颤动与亚临床甲状腺功能亢进症、甲状腺功能亢进的关系，本研究中95例心房颤动患者中有 7例门．37％）是甲状腺功能亢进症引起，10例门．5％）是亚临床甲状腺功能亢进症引起。60－79岁年龄段的亚临床甲状腺功能亢进症的发生率高于叩巧9岁年龄段（／－3．918，P－0．0舶）。4．结论： 40～59岁年龄段血清FT3、FT4水平升高与心房颤动有明显关系，60～79岁年龄段血清TSH水平降低与心房颤动有明显关系。亚临床甲状腺功能亢进症可能是老年人心房颤动发生的危险因子。更多还原

【Abstract】 Atrial fibrillation (AF) is a well-known manifestation of hyperthyroidism and occurs in 5 to 15 percent of patients with hyperthyroidism in different groups, and is especially prevalent over 60 years. Atrial fibrillation is an independent risk factor for arterial thromboembolism, stroke and congestive heart failure. Hence, the identification of risk factor for atrial fibrillation is important. Serum thyroid stimulating hormone (TSH) concentrations are a sensitive indicator of thyroid function. With the general availability of sensitive assays for measuring the concentration of TSH in serum, the entity of subclinical hyperthyroidism is being increasingly encountered. Subclinical hyperthyroidism is defined as a situation where the levels of the peripheral thyroid hormone are normal but serum TSH is low. It is not a rare finding; rates between 0.2% and 11.8% have been reported in different groups, according to age, sex, etc. Several studies found subclinical hyperthyroidism may be a risk factor for atrial fibrillation. We screened thyroid function markers in 234 patients in order to investigate the relationship between subclinical hyperthyroidism and atrial fibrillation.1. Objective:To investigate the relationship between subclinical hyperthyroidism and atrial fibrillation in Chinse.2. Materials and Methods2.1 PatientsNinety-fifth cases of patients with atrial fibrillation were divided into two groups (40-59 years and 60-79 years) according to age. Atrial fibrillation was diagnosed by electrocardiography performed at the biennial examinations. Some known risk factors for atrial fibrillation were excluded, including rheumatic heart disease, hypertension, coronary heart disease, congenital heart disease, dilated cardiomyopathy and sick sinus syndrome. Subjects who had taking iodine-containing preparations or thyroid hormone were also excluded.2.2 MethodsSerum levels of triiodothyronine ( T3 ) , thyroxine ( T4 ) , free triiodothyronine ( FT3 ) , free thyroxine ( FT4 ) and thyrotropin ( TSH ) were determined by immunochemiluminometric assay ( ICMA ) for ninety-fifth patients with atrial fibrillation and one hundred and thirty nine controls matched for age and sex.2.3 StatisticsAll statistical procedures were performed with SPSS 10.0 software package. Continuous variables were compared byt median of the Independent-Samples T Test. Differnces in distribution were compared by the Chi-square test or Fisher’s exact test if appropriate. P values below 0.05 were considered statistically significant. 3.Results:In 40-59 years atrial fibrillation group showed significantly higher serum FT3 (4.68+1.26 p mol/L, P = 0.016) and higher serum FT4 (17.74+4.36 p mol/L , P = 0.025) than control group . No significant differences were found in serum TSH, T4and T3 levels among atrial fibrillation group and control group. In 60-89 years atrial fibrillation group showed significantly lower serum TSH (1.62+1.38 m IU/L, P = 0.006) than control group. No significant differences were found in serum T3, T4, FT3 and FT4 levels among atrial fibrillation group and control group. Seven hyperthyroidism patients (7.37%) and ten subclinical hyperthyroidism patients (10.5%) were detected among atrial fibrillation group. In 60-89 years the incidence of subclinical hyperthyroidism patients showed higher than in 10-59 years (x2= 3.918, P = 0.048). 4.Conclusions:This study showed significant correlation between atrial fibrillation and serum higher FT3, FT4 levels in 40-59 years. However, it showed significant correlation between atrial fibrillation and serum lower TSH in 60-79 years. Subclinical hyperthyroidism may be a risk factor for atrial fibrillation in old people.更多还原