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目的:研究原发性甲状腺功能减退症患者的心电图(ECG)改变,及血清甲状腺激素(TH)水平与心电图改变的相关性,探讨TH对甲减患者心脏电生理活动的影响。方法:对144例原发性甲减患者(甲减组)和163例正常人(正常对照组)进行常规十二导联ECG检查,分别检测心率(HR)、PR间期(PR)、QRS波时限(QRS)、QT间期(QT)、ST段压低幅度、T波等,同时用化学发光法测定血清总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)和促甲状腺激素(TSH)水平,对心电图指标和血清TH水平行相关性分析。结果:甲状腺功能减退症中心电图异常率高于正常对照组(χ2=34.557,P=0.000)。TSH、T3及病程判断心电图异常的能力较好,差异有统计学意义(P<0.05)。甲减组心率显著低于正常对照组,PR间期、QRS时间、QT间期较正常对照组显著延长(P<0.01),心率与TSH、T3、T4呈显著正相关。PR间期、QRS时间、QT间期与T3、T4呈显著负相关,与TSH呈显著正相关。ST段压低、T波异常(倒置、低平或双向)与TSH呈显著负相关,与T3、T4呈显著正相关,差异有统计学意义(P<0.05)。结论:甲减组54.2%,正常组14.7%出现心电图异常,甲状腺功能减退症时随病程的延长、TSH的升高、T3的降低心电图会出现异常。原发性甲状腺功能减退症可对患者窦房结起搏产生显著影响,引起心脏自律性改变,并造成明显的心肌缺血损伤。
OBJECTIVE: To investigate the changes of electrocardiogram (ECG) and serum thyroid hormone (TH) levels in patients with primary hypothyroidism and the changes of electrocardiogram (ECG), and to explore the effect of TH on electrophysiological activity in patients with hypothyroidism. Methods: One hundred and forty-four patients with primary hypothyroidism (hypothyroidism) and 163 normal controls (normal control group) underwent routine 12-lead ECG examination. HR, PR interval, QRS (QRS), QT interval (QT), ST depression amplitude, T wave and so on. Meanwhile, the levels of total triiodothyronine (TT3), total thyroxine (TT4) and thyrotropin (TSH) levels, the correlation between ECG and serum TH levels were analyzed. Results: The abnormal rate of ECG in hypothyroidism was higher than that in normal control group (χ2 = 34.557, P = 0.000). TSH, T3 and course of disease to determine the abnormal ability of ECG is better, the difference was statistically significant (P <0.05). The heart rate of hypothyroidism group was significantly lower than that of the control group. The PR interval, QRS time and QT interval were significantly longer than those of the normal control group (P <0.01). The heart rate was positively correlated with TSH, T3 and T4. PR interval, QRS time, QT interval and T3, T4 showed a significant negative correlation, and TSH was significantly positively correlated. There was a significant negative correlation between ST segment depression and T wave abnormalities (inverted, low or bilateral) and TSH, and significant positive correlation with T3 and T4 (P <0.05). Conclusion: The hypothyroidism 54.2%, 14.7% of the normal group ECG abnormalities, hypothyroidism with the extension of the course of TSH, T3 decreased ECG abnormalities. Primary hypothyroidism can have a significant effect on sinus node pacing in patients, causing cardiac autonomic changes and causing significant myocardial ischemia.