亚临床甲状腺功能减退转归的影响因素  

Factors Influencing the Outcome of Subclinical Hypothyroidism

作　　者：高雁鸿[1] 王桂英[1] 程宇甫[1] 尉继林[2] 张年萍[3] GAO Yan-hong;WANG Gui-ying;CHENG Yu-fu;WEI Ji-lin;ZHANG Nian-ping(Department of Endocrinology,Fifth People's Hospital,Datong Shanxi,037009;Department of Laboratory,Fifth people's Hospital,Datong Shanxi,037009;Medical School,Shanxi Datong University,Datong Shanxi,037009)

机构地区：[1]大同市第五人民医院内分泌科,山西大同037009 [2]大同市第五人民医院检验科,山西大同037009 [3]山西大同大学医学院,山西大同037009

出　　处：《山西大同大学学报（自然科学版）》2018年第2期45-47,共3页Journal of Shanxi Datong University(Natural Science Edition)

摘　　要：目的探讨亚临床甲状腺功能减退转归的影响因素,为临床治疗提供依据。方法收集200例新诊断亚临床甲减患者的基线指标(性别、年龄、甲状腺超声、TPOAb等),随访2年,再次进行上述检查,观察亚临床甲减的自然转归及预后影响因素。结果 200例亚临床甲减患者均未接受治疗,随访2年后,55.0%自然缓解,37.5%仍为亚临床甲减,7.5%进展为临床甲减。自然缓解组基线TSH、hs-CRP、IL-6水平,TPOAb和TGAb阳性率以及ESR均明显低于未缓解组(P<0.05);自然缓解组基线Tg显著高于未缓解组(P<0.05);2组基线FT4和FT3水平及TRAb阳性率无显著差异(P>0.05)。自然缓解组除FT4和FT3水平在随访过程中未显著变化外,其余各项指标较基线水平均发生显著变化,其中TSH、hs-CRP、IL-6水平和ESR显著下降,TPOAb、TGAb、TRAb阳性率显著降低,Tg水平显著升高(P<0.05);未缓解组仅TSH水平和TPOAb阳性率显著降低(P<0.05)。Logistic回归分析显示hs-CRP<5.8 g/L、ESR<58.4 mm/h、IL-6<30.3 ng/L和Tg≥9.7 mg/L是亚临床甲状腺功能减退患者自然转归的影响因素。结论初始血清hs-CRP>5.8 g/L、ESR>58.4 mm/h、IL-6>30.3 ng/L和Tg<9.7 mg/L是促进亚临床甲减进展为临床甲减的危险因素,应重视血清学检测指标对临床治疗的指导意义。Objective To investigate the factors influencing the prognosis of subclinical hypothyroidism,and to provide evidence for clinical treatment.Methods Baseline indicators(gender,age,thyroid ultrasound,TPOAb,etc.)of 200 newly diagnosed subclinical hypothyroidism patients were collected,and accepted follow up 2 years after and above indexes were reexamined.To observe the natural outcome and prognostic factors of subclinical hypothyroidism.Results 200 patients with subclinical hypothyroidism were not treated.After 2 years of follow-up,110 cases(55%)had natural remission,75 cases(37.5%)remained subclinical hypothyroidism,and 15 cases(7.5%)progressed to clinical hypothyroidism.The baseline TSH,hs-CRP,IL-6,TPOAb and TGAb positive rate and ESR in natural relief group were significantly lower than those in the non remission group(P<0.05);Tg level was significantly higher than the non remission group(P<0.05).There was no significant difference between the two groups in the baseline FT4 and FT3 levels and the positive rate of TRAb(P>0.05).The natural remission group except FT4 and FT3 levels during follow-up did not change significantly,the rest indexes changed significantly compared to the baseline level,including TSH,hs-CRP,IL-6 and ESR decreased significantly,TPOAb,TGAb,TRAb positive rate was significantly decreased,Tg level increased significantly(P<0.05).only TSH level and the positive rate of TPOAb in non remission group were significantly decreased(P<0.05).Logistic regression analysis showed that hs-CRP<5.8g/L,ESR<58.4mm/h,IL-6<30.3ng/L and Tg≥9.7mg/L is subclinical hypothyroidism patients factors of natural outcome.Conclusion The initial serum hs-crp>5.8 g/l,esr>58.4 mm/h,il-6>30.3 ng/l and TG<9.7mg/l were the risk factors to promote the progression of subclinical hypothyroidism to clinical one.We should pay attention to the significance of serological detection index for clinical treatment.

关 键 词：亚临床甲状腺功能减退 基线指标 转归 

分 类 号：R581.2[医药卫生—内分泌]