晚间与早间服用左旋甲状腺素对甲状腺功能低下患者甲状腺素水平的影响  

Effect of taking L-T4 in bedtime vs morning on changes of serum thyroid hormone concentration in patients with hypothyroidism

作　　者：袁耿彪[1] 范永增[1] 严清波[1] 王玉婵[1] 杨鑫[1] 

机构地区：[1]重庆医科大学附属第二医院核医学科,400010

出　　处：《中华核医学与分子影像杂志》2015年第4期265-267,共3页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家卫生和计划生育委员会2013年临床重点专科建设项目

摘　　要：目的比较晚间与早间服用L-T4对甲状腺功能低下（简称甲低）患者的甲状腺激素水平的影响。方法对17例接受L-T4替代治疗的原发性甲低患者进行前瞻性分析，分别于早间服用L-T4 2个月后和改为晚间服用L-T4 2个月后测定TSH、FT3、FT4、三酰甘油、胆固醇、白蛋白、肌酐水平及心率。采用配对秩和检验或配对t检验比较2次测定指标的差异；采用Pearson相关分析法分析TSH变化与FT3、FT4变化的相关性。结果17例甲低患者早间服药后和改为晚间服药后，TSH、FT，、FT4分别为（12．10±7．19）比（3．90±3．47）mU／L、（4．14±0．86）比（5．24±1．11）pmol／L、（12．72±4．40）比（18．48±2．87）pmol／L，前后差异均有统计学意义（t=6．371、-3．166、-5．435，均P〈0．01）；TSH下降（8．20±5．31）mU／L，FT3上升（1．09±1．42）pmol／L，FT4上升（5．76±4．37）pmol／L，TSH下降与FT3、FT4上升之间无相关性（r=0．12、0．22，均P〉0．05）；2次测定的三酰甘油、胆固醇、白蛋白、肌酐水平及心率差异均无统计学意义（t=0．240、0．017，z=0，t=-0．610、1．588，均P〉0．05）。结论服用L-T4时间由早间改为晚间后，可以降低甲低患者TSH水平，提高FT3，、FT4的水平；既可以保持甲状腺激素水平的稳定，叉不需要增加L-T4的剂量。Objective To compare the effect of L-T4 taken in the morning vs bedtime on serum thy- roid hormone in patients with hypothyroidism. Methods Seventeen patients with primary hypothyroidism were prospectively included. They took L-T4 in the morning for 2 months followed by L-T4 taken during the bedtime for 2 months. Thyroid hormone levels and cholesterol, triglyceride, albumin, creatinine and heart rate were measured. Wilcoxon test and paired t test were used to compare the data. The correlation between the changes of TSH and FT3, FT4 was analyzed respectively by Pearson correlation analysis. Results TSH, FT3, FT4 were： （12.10±7.19） vs （3.90±3.47） mU/L, （4.14±0.86） vs （5.24±1.11） pmol/L, （12.72± 4. 40） vs （18.48±2.87） pmol/L for L-T4 taken in the morning and during the bedtime respectively （ t val- ue： 6.371, -3.166, -5.435, all P〈0.01）. There was no correlation between the changes of TSH and FT3 , FT4（r=0.12, 0.22, both P〉0.05）, respectively. The averaged changes were （8.20±5.31） mU/L, （ 1.09± 1.42） pmol/L and （ 5.76± 4.37 ） pmol/L. Triglyceride, cholesterol, albumin, creatinine levels and heart rate were not significantly different with L-T4 taken in the morning and during bedtime （t =0.240, 0.017; z=0; t =-0.610, 1.588, all P〉0.05）. Conclusions L-T4 taken during the bedtime by patients with hypothyroid- ism would reduce TSH and increase FT3, ETa levels. This method can maintain the stability of TSH level with no need to increase the dose.

关 键 词：甲状腺功能减退症 甲状腺素 用药计划表 

分 类 号：R581.2[医药卫生—内分泌]