Czekalski S, Widecka K, Gozdzik J, Ciechanowski K, Krzyzanowska-Swiniarska B, Gromniak E, Gruszczynska M
Department of Endocrinology and Metabolic Diseases, Pomeranian University School of Medicine, Szczecin, Poland.
J Endocrinol Invest. 1994 May;17(5):341-6. doi: 10.1007/BF03348996.
Plasma immunoreactive atrial natriuretic peptide (ANP) and cyclic guanosine monophosphate (cGMP), serum thyroxine (T4), triiodothyronine (T3), and thyrotropin (TSH) concentrations were measured in 11 patients with thyrotoxicosis and atrial fibrillation (group 1), in 5 patients with thyrotoxicosis and sinus cardiac rhythm (group 2) and in 8 healthy subjects in comparable age. Patients with thyrotoxicosis were studied before and after treatment with methimazole (3 x 20 mg daily) during 10 days. During treatment sinus cardiac rhythm returned in 6 patients with initial fibrillation (group 1a) while 5 patients still presented atrial fibrillation at the end of the study (group 1b). All patients from group 2 maintained a sinus cardiac rhythm throughout the study. Median plasma concentrations of ANP and cGMP before treatment in patients from group 1 were higher: 43.8 pmol/l and 11.0 nmol/l, respectively than in patients from group 2: 20.0 pmol/l (p < 0.005) and 6.5 nmol/l (p < 0.01), respectively. In all groups of patients methimazole treatment resulted in a significant decrease of plasma ANP and cGMP concentrations in parallel to a reduction of serum T3 and T4 levels. After therapy, plasma ANP and cGMP levels in patients from group 1a were not significantly different from those in patients from group 2, while in patients from group 1b remained slightly elevated. Presented results suggest that atrial fibrillation in patients with thyrotoxicosis represents an important factor augmenting plasma ANP and cGMP levels, in addition to the stimulatory effect exerted by thyroid hormones. However, the marked reduction of serum thyroid hormones produced by short-term methimazole treatment in patients with thyrotoxicosis was associated with parallel decrease of plasma ANP and cGMP levels toward normal values. Therefore, the influence of thyroid hormones on plasma ANP and cGMP concentrations seems relatively more important than the effect of atrial fibrillation.
对11例甲状腺毒症伴心房颤动患者（第1组）、5例甲状腺毒症伴窦性心律患者（第2组）以及8名年龄相仿的健康受试者测定了血浆免疫反应性心房利钠肽（ANP）和环磷酸鸟苷（cGMP）、血清甲状腺素（T4）、三碘甲状腺原氨酸（T3）以及促甲状腺激素（TSH）的浓度。甲状腺毒症患者在接受甲巯咪唑（每日3次，每次20mg）治疗10天前后进行研究。治疗期间，6例初始为心房颤动的患者（第1a组）恢复为窦性心律，而5例患者在研究结束时仍存在心房颤动（第1b组）。第2组的所有患者在整个研究过程中均维持窦性心律。第1组患者治疗前血浆ANP和cGMP的中位数浓度分别为43.8pmol/l和11.0nmol/l，高于第2组患者，分别为20.0pmol/l（p<0.005）和6.5nmol/l（p<0.01）。在所有患者组中，甲巯咪唑治疗导致血浆ANP和cGMP浓度显著降低，同时血清T3和T4水平也降低。治疗后，第1a组患者的血浆ANP和cGMP水平与第2组患者无显著差异，而第1b组患者的血浆ANP和cGMP水平仍略有升高。研究结果表明，甲状腺毒症患者的心房颤动是除甲状腺激素的刺激作用外，增加血浆ANP和cGMP水平的一个重要因素。然而，短期甲巯咪唑治疗使甲状腺毒症患者血清甲状腺激素显著降低，同时血浆ANP和cGMP水平也随之降至正常。因此，甲状腺激素对血浆ANP和cGMP浓度的影响似乎比心房颤动的影响更为重要。
