亚临床甲减L-T_4干预治疗的前瞻性病例对照研究  

Levothyroxine treatment for subclinical hypothyroidism: a prospective case control study

作　　者：鲁丽[1,2] 孙鑫[1] 单玲[1] 王洋[1] 刘晓楠 赵晓娟[2] 

机构地区：[1]辽宁省人民医院内分泌科,沈阳110023 [2]中国医科大学附属第一医院内分泌科,沈阳110001

出　　处：《实用药物与临床》2017年第11期1248-1252,共5页Practical Pharmacy and Clinical Remedies

基　　金：国家自然科学基金(81570711);辽宁省自然科学基金(201602426)

摘　　要：目的观察亚临床甲状腺功能减退症(亚临床甲减,SCH)患者用左甲状腺素(L-T_4)干预治疗对血脂、血压、心率、心功能的影响。方法根据1周内2次促甲状腺激素(TSH)>4.8 m U/L且游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT_4)正常为标准,于2015年7月至2016年4月分别从我院体检中心筛查出SCH患者11例,内分泌科门诊收集SCH患者86例,共计97例随机分成4组,随访1年,TSH≥10.0 m U/L且未干预者为A组(11例),TSH≥10.0 m U/L且用L-T_4干预者为B组(23例),4.8 m U/L<TSH<10.0 m U/L且用L-T_4未干预者为C组(37例),4.8 m U/L<TSH<10.0 m U/L干预者为D组(26例)。全部SCH患者每3个月随诊1次,进行体格检查,测定TSH、FT3、FT_4、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(Tg Ab)及血脂浓度,同时进行心功能检测,并根据甲功结果调整L-T_4的剂量。结果共有82例(84.5%)SCH患者完成了随访。(1)血脂:LT_4干预后,B组的总胆固醇(TC)低于A组[(4.13±0.19)mmol/L vs.(4.92±0.27)mmol/L,P<0.05),而随访前后C组和D组比较差异无统计学意义(P>0.05);低密度脂蛋白胆固醇(LDL)、三酰甘油(TG)和高密度脂蛋白胆固醇(HDL)各组间以及随访前后变化差异均无统计学意义(P>0.05)。(2)血压、心率和心功能:随访后B组和C组舒张压均下降(P<0.05),干预前后四组间收缩压、心率比较差异均无统计学意义(P>0.05)。未干预者射血分数由64.02%±5.25%降到62.28%±5.31%,干预者由62.27%±4.58%上升至63.18%±3.98%,但随访前后、干预与未干预者间差异均无统计学意义(P>0.05)。结论 L-T_4干预对TG、HDL、LDL、血压、心率以及心功能无明显影响;对于TSH≥10.0 m U/L的SCH患者应用L-T_4可降低TC的水平。Objective To assess the effect of L-T_4 intervention treatment for subclinical hypothyroidism on lipid profiles,blood pressure,heart rate and heart function. Methods Eleven patients from the Center of Health Examination and 86 from out-patient clinic of Endocrine Department with SCH（ TSH 4. 8 m U/L and FT3,FT_4 levels in the normal reference range） were identified from the laboratory database after they had had at least two TSH tests in a week and one thyroid function test measured from July 2015 to April 2016. These 97 participants were randomly divided into 4 groups according to the level of TSH and with or without treatment with L-T_4,then follow-up lasted for one year. The 34 patients with TSH≥10. 0 m U/L were divided into two groups： 23 in group B with L-T_4 intervention and11 in group A without. The other 63 patients with 4. 8 m U/L TSH 10. 0 m U/L were divided into two groups： group C（ n = 37） without intervention and group D（ n = 26） with L-T_4 intervention. All patients had physical examination every 3 months and the levels of TSH,FT3,FT_4,TPOAb,Tg Ab,lipid profiles and heart function were measured at the same time. The L-T_4 dosage was adjusted according to the serum TSH concentrations. Results Totally 82 patients（ 84. 5%） completed the full study protocol. In group B,the level of serum TC was decreased after L-T_4 intervention.This lower level was significantly different from group A,in which the level of serum TC was increased after one year（ P〈0. 05）. The levels of serum TC were not significantly different between group C and group D. The levels of LDL,TG,HDL,systolic blood pressure,heart rate and ejection fraction were not significantly different among 4 groups（ P〈0. 05）,although L-T_4 treatment increased mean ejection fraction from 62. 27% ± 4. 58% to 63. 18% ± 3. 98% and the level of patients without L-T_4 treatment was decreased from 64. 02% ± 5. 25% to 62. 28% ± 5. 31%. The diastolic blood pressure level was decreased after follow-up period in all groups and

关 键 词：亚临床甲状腺功能减退症(SCH) 左甲状腺素(L-T4) 血脂 血压 心率 心功能 

分 类 号：R581.2[医药卫生—内分泌]