Pingitore Alessandro, Iervasi Giorgio
Consiglio Nazionale Delle Ricerche, Istituto di Fisiologia Clinica, CNR, Pisa.
Recenti Prog Med. 2005 Nov;96(11):535-41.
Experimental and clinical findings strongly support the concept that thyroid hormone (TU) has a fundamental role in the cardiovascular homeostasis both in physiological and pathological conditions. In heart failure (HF) the main alteration of the thyroid function is referred to as low-T3 syndrome characterized by the reduction in serum total T3 and free T3 with normal levels of thyroxine and thyrotropin. This syndrome, that affects one third of HF patients, is considered as adaptive factor minimizing catabolic phenomena of illness. However this interpretative hypothesis is actually questioned. In fact experimental data showed the potential effects of this syndrome in the progressive deterioration of cardiac function and myocardial remodeling of HF. Prognostic studies have shown that T3 levels represent a powerful predictor of mortality in HF patients, also adding prognostic power to conventional cardiac parameters. Large, multicenter, placebo controlled prospective studies will provide the safety and prognostic effects of the chronic treatment with thyroid hormones in HF.
实验和临床研究结果有力地支持了这样一种观点，即甲状腺激素（TH）在生理和病理状态下的心血管稳态中都起着至关重要的作用。在心力衰竭（HF）中，甲状腺功能的主要改变被称为低T3综合征，其特征是血清总T3和游离T3降低，而甲状腺素和促甲状腺素水平正常。这种综合征影响三分之一的HF患者，被认为是一种适应性因素，可将疾病的分解代谢现象降至最低。然而，这一解释性假设实际上受到了质疑。事实上，实验数据表明，该综合征对HF患者的心功能进行性恶化和心肌重塑具有潜在影响。预后研究表明，T3水平是HF患者死亡率的有力预测指标，也为传统心脏参数增加了预后价值。大型、多中心、安慰剂对照的前瞻性研究将提供甲状腺激素长期治疗HF的安全性和预后效果。
