Laohathai Phakwan, Sumboonnanonda Rathaporn, Saengpanit Puthita, Vijarnsorn Chodchanok, Srisawat Chatchawan, Chotipanang Kwanjai, Junnu Sarawut, Kunnangja Supawan, Rukprayoon Hathaichanok, Phuangphan Phakkanan, Liammongkolkul Sompong, Phaokong Arthima, Densupsoontorn Narumon
Division of Nutrition, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Division of Cardiology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Clin Exp Pediatr. 2025 Sep;68(9):666-672. doi: 10.3345/cep.2024.01893. Epub 2025 Apr 16.
Thiamin deficiency (TD) manifesting clinically as wet beriberi can significantly impair a patient's cardiac function. Children with heart disease who are receiving diuretic treatment may be at increased risk for severe clinical manifestations of TD.
This study aimed to determine the prevalence of TD and evaluate the association between various factors with thiamin status in pediatric patients with heart disease undergoing diuretic treatment.
Children with heart disease aged 1 month to 15 years who exhibited increased pulmonary blood flow or congestive heart failure (CHF) and had been taking diuretics for at least 1 month were recruited. Data regarding their heart condition, treatment, dietary intake, anthropometry, and symptoms and signs of TD were collected. An erythrocyte transketolase activity assay after the addition of exogenous thiamin pyrophosphate was used to assess thiamin status. Left ventricular ejection fraction and N-terminal pro-brain natriuretic peptide levels were indicators of cardiac function and laboratory evidence of CHF, respectively.
A total of 68 participants were recruited, of whom 10 (15%) had TD. TD was not associated with a CHF exacerbation. An adequate dietary thiamin intake was associated with a better thiamin status (β=-0.37, P=0.003), while increasing age was linked to a poorer thiamin status (β=+0.40, P=0.001).
TD was present in 15% of pediatric patients with heart disease who were receiving diuretic treatment. An adequate dietary thiamin intake appeared to have a protective effect against TD, while increasing age was associated with a poorer thiamin status.
临床上表现为湿性脚气病的硫胺素缺乏症（TD）可显著损害患者的心功能。接受利尿剂治疗的心脏病患儿发生TD严重临床表现的风险可能增加。
本研究旨在确定TD的患病率，并评估接受利尿剂治疗的小儿心脏病患者中各种因素与硫胺素状态之间的关联。
招募年龄在1个月至15岁之间、表现为肺血流量增加或充血性心力衰竭（CHF）且已服用利尿剂至少1个月的心脏病患儿。收集有关他们的心脏状况、治疗、饮食摄入、人体测量以及TD的症状和体征的数据。添加外源性硫胺素焦磷酸后进行红细胞转酮醇酶活性测定以评估硫胺素状态。左心室射血分数和N末端脑钠肽前体水平分别是心功能和CHF实验室证据的指标。
共招募了68名参与者，其中10名（15%）患有TD。TD与CHF加重无关。充足的饮食硫胺素摄入量与较好的硫胺素状态相关（β=-0.37，P=0.003），而年龄增长与较差的硫胺素状态相关（β=+0.40，P=0.001）。
接受利尿剂治疗的小儿心脏病患者中15%存在TD。充足的饮食硫胺素摄入量似乎对TD有保护作用，而年龄增长与较差的硫胺素状态相关。
