摘要
目的长期服用胺碘酮引起甲状腺功能异常增高,且在不同地区胺碘酮引起甲状腺功能异常的类型差异很大.本文观察广东地区老年心律失常患者长期口服胺碘酮导致甲状腺功能异常的临床特征及转归.方法263例口服胺碘酮老年患者,其中男性184例,女性79例,年龄60～87平均(74.6±11.3)岁.在服药前均经放射免疫法测定血液甲状腺功能,排除了甲状腺功能异常.在服药中和停药后半年多次测定甲状腺功能,并同时测定自身免疫学指标TGA、MCA、TG.结果随访过程中出现甲状腺功能异常的老年患者62例,其中男性45例,女性17例.本组患者中,服用胺碘酮后甲状腺功能异常出现时间最短为3周,最长为2.5年.11例服药后出现甲状腺功能亢进,51例出现甲状腺功能减退,82%的患者在停药3个月后T3、T4、FT3、FT4恢复正常,而只有23%的患者TSH恢复.所有患者服药前、服药中和停药后自身免疫学指标甲状腺球蛋白(TGA)、甲状腺球蛋白抗体(MCA)、甲状腺微粒体抗体(TG)均未发现明显改变.结论在广东地区,胺碘酮引起甲状腺功能异常以甲状腺功能减退为主,临床病程个体差异较大;自身免疫在胺碘酮所致的甲状腺功能异常中不起主要作用;胺碘酮引起的甲状腺功能异常在停药后均可恢复,无需长期治疗.
Objective Long-term amiodarone therapy could cause abnormal thyroid function and there was a significant difference in types of dysfunction from area to area, The aim of this study was to observe the clinical features and prognosis of thyroid dysfunction induced by long-term oral amiodarone therapy in elderly patients with arrhythmias in Guangdong province. Methods Total of 263 subjects including 184 male and 79 female elderly patients with oral amiodarone therapy were selected, with age ranged from 60 to 87 [ mean, （74. 6 ± 11.3 ）] years old. Thyroid function was measured by radioimmunoassay before medication, excluding thyroid dysfunction condition. As well as immunological indexes such as the serum level of TGA ,MCA and TG were measured several times during medication and 6 months after discontinuing amiodarone therapy. Results Sixty-two of 263 eases（45 male and 17 female）were confirmed with amiodarone-induced thyroid dysfunction （AITD） during follow-up. Clinical symptoms appeared after 3 weeks（earliest） or after 2. 5 years（latest）. There were 11 cases with hyperthyroidism and 51 cases with hypothyroidism after medication. Serum T3, T4, FT3 and FT4 levels returned to normal among 82% patients and only 23% patients with TSH level recovery after discontinuing medication for three months. Among all these subjects, no remarkable changes were found in the measurement of TGA, MCA and TG throughout the study. Conclusions Hypothyroid is the major type among the AITD in Guangdong, and there is a great individual variation during clinical course. It could be showed that autoimmunity does not play a major role in AITD;so long-term replacement therapy is not necessary and AITD could recover after discontinuing medication.
出处
《中华心律失常学杂志》
2005年第5期375-377,共3页
Chinese Journal of Cardiac Arrhythmias
