[先天性甲状腺功能减退症新生儿甲状腺素替代治疗前后的左心室功能]

[Left ventricular function in congenital hypothyroidism neonates before and after thyroxine substitution therapy].

作者信息

Mao Shan-shan, Zhao Zheng-yan, Jiang Guo-ping

机构信息

Department of Child Health Care, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2005 Mar 2;85(8):538-41.

PMID:15949334

Abstract

OBJECTIVE

To evaluate left the systolic and diastolic functions in neonates with congenital hypothyroidism (CH) as well as the effect of thyroxine substitution therapy on left ventricular function and its correlation with thyroid hormones serum levels.

METHODS

M-mode echocardiography was used to examine the left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS), pulse wave Doppler was used to examine the peak early diastolic mitral inflow velocity (E(m)) and peak late diastolic mitral inflow velocity (A(m)), quantitative tissue velocity imaging (QTVI) was used to examine the systolic peak mitral annular velocity (s(m)), early diastolic peak mitral annular velocity (E(m)), and the late diastolic peak mitral annular velocity (a(m)), and tissue tracking imaging (TTI) was used to detect the systolic mitral annular displacement (MAD) in 40 neonates with congenital hypothyroidism aged 15-28 days before and after 1-month levothyroxine substitution treatment. Thirty normal neonates were used as controls. Chemiluminescent immunoassay was used to measure the TT(3), TT(4) and TSH levels. Correlation analysis was also made between the ventricular function parameters and the serum TT(3), TT(4), and TSH levels.

RESULTS

The left systolic function parameters (LVEF, s(m), MAD, E(m) and e(m)) was 0.61 +/- 0.08, 2.60 cm/s +/- 0.60 cm/s, 0.29 cm +/- 0.06 cm, 0.59 m/s +/- 0.12 m/s and 2.72 cm/s +/- 1.43 cm/s respectively, in CH group, and 0.67 +/- 0.06, 3.25 cm/s +/- 0.51 cm/s, 0.41 cm +/- 0.08 cm, 0.72 m/s +/- 0.11 m/s and 4.51 cm/s +/- 1.23 cm/s in control group (P < 0.01). Left function in CH neonates before treatment were all lower than those of the controls (P < 0.01), which significantly increase after 1-months L-T(4) substitution therapy, 0.69 +/- 0.05, 3.46 cm/s +/- 0.64 cm/s, 0.45 cm +/- 0.08 cm, 0.82 m/s +/- 0.17 m/s and 5.09 cm/s +/- 1.37 cm/s, (P < 0.01). Those parameters were positively correlated with TT(4) serum levels (P < 0.01), and were negatively correlated with TSH (all P < 0.01). In particular, MAD, sm, E(m), and em were highly correlated with serum TT(4) and TSH (r = 0.667, 0.538, 0.478, and 0.599 respectively, all P < 0.001;and r = -0.670, -0.521, -0.490, and -0.583 respectively, all P < 0.001).

CONCLUSION

Neonates with CH have lower left systolic and diastolic functions. Early L-T(4) substitution therapy can reverse these changes.

摘要

目的

评估先天性甲状腺功能减退症（CH）新生儿的左心室收缩和舒张功能，以及甲状腺素替代治疗对左心室功能的影响及其与血清甲状腺激素水平的相关性。

方法

采用M型超声心动图检测40例年龄在15 - 28天的先天性甲状腺功能减退症新生儿左心室射血分数（LVEF）和左心室短轴缩短率（LVFS），脉冲波多普勒检测二尖瓣舒张早期血流峰值速度（E(m)）和舒张晚期血流峰值速度（A(m)），定量组织速度成像（QTVI）检测二尖瓣环收缩期峰值速度（s(m)）、舒张早期峰值速度（E(m)）和舒张晚期峰值速度（a(m)），组织追踪成像（TTI）检测二尖瓣环收缩期位移（MAD），在左甲状腺素替代治疗1个月前后进行检测。30例正常新生儿作为对照。采用化学发光免疫分析法检测TT(3)、TT(4)和TSH水平。同时对心室功能参数与血清TT(3)、TT(4)和TSH水平进行相关性分析。

结果

CH组左心室收缩功能参数（LVEF、s(m)、MAD、E(m)和e(m)）分别为0.61±0.08、2.60 cm/s±0.60 cm/s、0.29 cm±0.06 cm、0.59 m/s±0.12 m/s和2.72 cm/s±1.43 cm/s，对照组分别为0.67±0.06、3.25 cm/s±0.51 cm/s、0.41 cm±0.08 cm、0.72 m/s±0.11 m/s和4.51 cm/s±1.23 cm/s（P<0.01）。CH新生儿治疗前的左心室功能均低于对照组（P<0.01），左甲状腺素替代治疗1个月后显著升高，分别为0.69±0.05、3.46 cm/s±0.64 cm/s、0.45 cm±0.08 cm、0.82 m/s±0.17 m/s和5.09 cm/s±1.37 cm/s（P<0.01）。这些参数与血清TT(4)水平呈正相关（P<0.01），与TSH呈负相关（均P<0.01）。特别是，MAD、s(m)、E(m)和e(m)与血清TT(4)和TSH高度相关（r分别为0.667、0.538、0.478和0.599，均P<0.001；r分别为 - 0.670、 - 0.521、 - 0.490和 - 0.583，均P<0.001）。