| Objectives: As the breakthrough point,spironolactone which is the aldosterone receptor antagonist can affect the level of thyroid hormone.After intervention in patients with heart failure and low T3 syndrome,we will observe the changes about aldosterone level on recumbent position, left ventricular function and thyroid function.Make the clear that spironolactone can improve heart function and the low T3 state, and revealing the important position of spironolactone in improving heart failure,which can provide clinical basis for further investigating the molecular mechanism of aldosterone which affects TH level.Methods: Selecting 80 patients(54 ischemic cardiomyopathy,26 dilated cardiomyopathy) with heart failure and low T3 syndrome who were diagnosed in department of cardiology of Tianjin Forth Centre Hospital and meet the cardiac function class IV in New York Heart Association(NYHA) between 2012-1 to 2013-6.Exclusion criteria: chronic lung diseases and respiratory failure, stroke, malignant tumor, severe infection, hepatic insufficiency(ALT> 40u/L), renal insufficiency:GFR<60m L/(min· 1.73m2), diabetes and other endocrine diseases, secondary hypertension, and who were not able to tolerance spironolactone.Patients were randomly divided into control group(40 cases) and spironolactone group(40 cases).Two groups are both used routinely digoxin,fueosemide,ACEI,and other heart failure drugs.Spironolactone group had 40 mg spironolactone daily oral for 16 weeks,but control group did not have.Patients were do heart echocardiography to determinate LVEF and LVEDD after the next day of test begin and the end.Venous blood on an empty stomach was collected after the next day morning of test begin and the end, which was used for testing the aldosterone level on recumbent position and TH levels, including free T3, free T4, and TSH.At the same time,detecting potassium levels of serum and NT-pro BNP, cardiac function,TH level,and the adverse reactions after taking spironolactone.Results:(1)The aldosterone level of spironolactone group and compared group after treatment were significantly decreased(P<0.01),the spironolactone group was more significant than compared group(P<0.01).(2)FT3 level increased significantly (P<0.01), the TSH levels significantly decreased(P<0.05), FT4 level had no significant change(P>0.05).(3) The LVEF of spironolactone group after treatment increased significantly(P<0.01),but LVEDD had no significant change(P>0.05).(4) The NT-pro BNP level of spironolactone group had significant change(P<0.01).(5) The potassium levels of spironolactone group after treatment had no significant change(P>0.05), and did not appear adverse reactions after taking spironolactone.Conclusions:(1) Spironolactone could make aldosterone level low,and at the same time which could raise the level of FT3, lower the level of TSH, improve the low T3 state, improve left ventricular ejection fraction and improve heart failure state among the patients who had heart failure and low T3 syndrome.(2) The LVEF and NT-pro BNP improved but the LVEDD had no change,only means improved the left ventricular systolic function.(3) The application of spironolactone did not appear obvious adverse reactions and complications, which was safety in the clinical application.(4)Spironolactone could play a positive role and had one important position in the treatment of heart failure.Its mechanism may be related to that spironolactone can antagonism aldosterone which participate in the regulation for the nuclear T3 receptor, improve the state of low T3 syndrome after heart failure.The study edpound the possible new mechanism of improved cardiac function by spironolactone. |
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