心血管疾病合并正常甲状腺功能病态综合征的物质代谢研究  

Study of metabolic dysfunction in patients with cardiovascular disease accompanied by euthyroid sick syndrome

作　　者：王美玲[1] 李海燕[1] 鄂立平[1] 崔晓婷[1] 于萍[1] 

机构地区：[1]北京市和平里医院心内科,北京100013

出　　处：《中国医药导报》2017年第2期70-73,共4页China Medical Herald

基　　金：北京市和平里医院科研项目(2016-I-03)

摘　　要：目的提高对心血管疾病(CVD)合并正常甲状腺功能病态综合征(ESS)的临床特点认识,为进一步的临床干预、改善疾病预后提供依据。方法回顾性分析2016年5~9月在北京市和平里医院心内科住院的143例CVD患者入院前3 d的临床资料,分为ESS组(28例)和正常甲状腺功能(EUT)组(115例),比较两组蛋白质、葡萄糖和脂质代谢、炎性反应及心功能等临床指标。结果 ESS组血浆白蛋白(Alb)、血红蛋白(Hb)、总胆固醇(TC)、三酰甘油的自然对数(lgTG)和高密度脂蛋白胆固醇(HDL-C)均小于EUT组(均P<0.05);ESS组血尿素氮(BUN)、游离脂肪酸(FFA)、C反应蛋白(CRP)和B型脑钠肽(BNP)的自然对数lgBUN、lgFFA、lgCRP和lgBNP以及血白细胞(WBC)和嗜中性粒细胞(NEU)均高于EUT组(均P<0.05);两组血低密度脂蛋白胆固醇(LDL-C)以及肌酐(Cr)、空腹血糖(FBG)和糖化血红蛋白(Hb A1c)的自然对数lgCr、lgFBG和lgHb A1c比较,差异均无统计学意义(均P>0.05)。结论 CVD合并ESS患者存在严重代谢紊乱,包括合成代谢减低、分解代谢增强、被掩盖的胰岛素抵抗和FFA氧化增强,同时伴有严重的炎性反应和心功能下降。Objective To improve recognition of clinical characteristics of cardiovascular diseases （CVD） accompanied by euthyroid sick syndrome （ESS）, in order to provide evidence for further clinical intervention and improvment of prognosis of disease. Methods A total of 143 cases with CVD admitted to Department of Cardiology, Beijing Hepingli Hospital between May and September 2016 were retrospectively analyzed and divided into ESS group with 28 cases and euthyroidism＇ （EUT） group with 115 cases. Clinical parameters of protein, glucose, lipid, inflammation and cardiac function were compared between the two groups. Results Compared with EUT group, ESS gorup pateints presented with lower plasma albumin （Alb）, hemoglobin （Hb）, total cholesterol （TC）, natural logarithm of triglyceride （lgTG） and high density lipoprotein Cholesterol （HDL-C） （P 〈 0.05）, and higher blood white blood cell （WBC）, neutrophil （NEU） and nat- ural logarithm of blood urea nitrogen （lgBUN）, free fatty acid （lgFFA）, C reactive protein （lgCRP） and B type natriuretic peptide （lgBNP） （P 〈 0.05）. Low density lipoprotein cholesterol （LDL-C） and natural logarithm of creatine （lgCr）, fasting blood glucose （lgFBG） and glycated hemoglobin （lgHbAlo） were not statistically different between ESS and EUT groups （P 〉 0.05）. Conclusion Severe metabolic dysfunction is found in CVD patients accompanied by ESS, including de- creased anabolism, increased catabolism, enhanced FFA oxidation, covered insulin resistance, more pronounced inflam- mation and more severe cardiac dysfunction.

关 键 词：正常甲状腺功能病态综合征 低白蛋白血症 游离脂肪酸 B型脑钠肽 

分 类 号：R54[医药卫生—心血管疾病]