亚临床甲状腺功能减退症患者 TSH 与动脉粥样硬化相关因子关系的研究  

Relationship of TSH with atherosclerosis-related factors in subclinical hypothyroidism

作　　者：田利民[1] 杨斌[3] 高翠霞[2] 刘静[1] 郭茜[1] 

机构地区：[1]甘肃省人民医院内分泌科,兰州730000 [2]甘肃省人民医院超声科,兰州730000 [3]宁夏医科大学,银川750000

出　　处：《中华内分泌代谢杂志》2015年第2期133-135,共3页Chinese Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金（81160100）;甘肃省卫生行业项目科研计划（GSWST2011-01）

摘　　要：250例初次诊断的亚临床甲状腺功能减退症（SCH）患者和120名健康志愿者,根据 TSH 水平将患者分为2组：A 组 TSH＜10 mIU/ L,B 组 TSH＞10 mIU/ L,B 组进行左旋甲状腺素（L-T4）替代治疗；比较甲状腺功能、血脂及动脉粥样硬化相关指标。 SCH 患者总胆固醇、低密度脂蛋白胆固醇（ low-density lipoprotein cholesterol, LDL-C）、非对称二甲精氨酸（asymmetric dimethyl arginine, ADMA）、颈动脉内膜中层厚度（carotid artery intima media thickness, CIMT）、血栓素 B2（thromboxane B2,TXB2）、C 反应蛋白（C-reactive protein, CRP）高于正常组,一氧化氮（nitric oxide, NO）低于正常组（均 P＜0.05）。 B 组 L-T4治疗后 TSH 恢复正常,总胆固醇、LDL-C、ADMA、CIMT、血栓素 B2下降,NO 升高（均 P＜0.05）。相关分析显示 TSH 与总胆固醇、LDL-C、ADMA、CIMT、血栓素 B2正相关,与 NO 负相关；多元逐步线性回归分析显示 TSH 是 CIMT、NO 的独立影响因素。高 TSH 是 SCH 患者发生动脉粥样硬化的重要危险因素。Two hundred and fifty patients with subclinical hypothyroidism （ SCH） and 120 euthyroid volunteers were recruited for the study, SCH patients were stratified into 2 groups according to TSH levels（group A：TSH〈10 mIU/ L; group B： TSH〉10 mIU/ L）. All subjects were examined for clinical characteristics, thyroid profile, lipid profile, and biomarkers of early atherosclerosis. Patients in group B received L-thyroxine replacement treatment to achieve euthyroidism. After 6 months of stable euthyroidism all measurements were repeated. SCH patients had higher levels of total cholesterol（TC）, low-density lipoprotein-cholesterol（LDL-C）, asymmetric dimethyl arginine （ADMA）, carotid artery intima media thickness（CIMT）, thromboxane B2（TXB2）, and C-reactive protein（CRP） but with lower nitric oxide（NO） level compared with euthyroid subjects. Levels of TC, LDL-C, CIMT, TXB2, and ADMA decreased, and NO level increased significantly after 6 months of euthyroidism. TSH was positively correlated with TC, LDL-C, CIMT, ADMA, and TXB2; and negatively correlated with NO. Based on multivariate regression analysis, TSH was an independent influential factor of CIMT and NO. We conclude that raised TSH is an important risk factor of atherosclerosis in SCH.

关 键 词：甲状腺功能减退症 促甲状腺素 动脉粥样硬化 左旋甲状腺素 

分 类 号：R543.5[医药卫生—心血管疾病] R581.2[医药卫生—内科学]