左旋甲状腺素对甲状腺功能减退患者脂代谢的影响  

Effects of levothyroxine on lipid metabolism in patients with hypothyroidism

作　　者：刘丽[1] LIU Li(Department of Endocrinology,Tieling Central Hospital,Liaoning,Tieling 112000,China)

机构地区：[1]辽宁省铁岭市中心医院内分泌科二病房,112000

出　　处：《河北医药》2019年第3期384-387,共4页Hebei Medical Journal

摘　　要：目的探讨左旋甲状腺素对甲状腺功能减退患者脂代谢的影响。方法选取2016年10月至2017年10月就诊的153例甲状腺功能减退患者,根据甲状腺功能筛查结果分为3组,其中A组48例:亚临床甲状腺功能减退症[促甲状腺激素(TSH) 5～10 m U/L]; B组43例:亚临床甲状腺功能减退症(TSH> 10 m U/L); C组62例:临床甲状腺功能减退症。根据患者的病情,给予不同剂量的左旋甲状腺素治疗,治疗3个月;比较3组患者治疗前后的甲状腺功能及相关抗体、血脂、载脂蛋白。结果 3组治疗前的TSH、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、抗甲状腺球蛋白抗体(A-TG)、抗甲状腺过氧化物酶抗体(A-TPO)、高密度脂蛋白(HDL-C)比较,差异无统计学意义(P> 0. 05); C组治疗前的胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白(LDL-C)、载脂蛋白A1(Apo-A1)、载脂蛋白B(Apo-B)、脂蛋白(a)[Lp(a)]与A组比较,差异均有统计学意义(P <0. 05); C组与B组、B组与A组比较,差异无统计学意义(P> 0. 05);治疗后,B组、C组的TSH、TC、TG、LDL-C、Apo-A1、Apo-B、Lp(a)与治疗前比较,差异均有统计学意义(P <0. 05); A组的TSH、TC、TG、LDL-C、Apo-A1、Apo-B、Lp(a)与治疗前比较,差异无统计学意义(P> 0. 05)。结论甲状腺功能减退患者存在不同程度的脂代谢紊乱,采取左旋甲状腺素治疗可改善甲状腺功能,具有一定的降脂效应;左旋甲状腺素对不同类型甲状腺功能减退患者的差异性作用以及在改善脂代谢异常中所发挥的作用及分子机制,还需进一步探讨。Objective To explore the effects of levothyroxine on lipid metabolism in patients with hypothyroidism.Methods A total of 151 patients with hypothyroidism,who were treated in our hospital from October 2016 to October 2017,were divided into subclinical hypothyroidism group A[(TSH)5~10 mU/L](n=48),subclinical hypothyroidism group B[(TSH >10 mU/L)](n=43)and clinical hypothyroidism group C(n=62)according to the results of thyroid function screening.The patients in the three groups were treated by different doses of levothyroxine for 3 months according to the disease conditions.The thyroid function,related antibodies,lipids and apolipoprotein of the patients in the three groups before and after treatment were observed and compared.Results Before treatment there were no significant differences in the levels of TSH,free triiodothyronine(FT3),free thyroxine(FT4),antithyroglobulin antibody(ATG),antithyroid peroxidase antibody(ATPO)and high density lipoprotein(HDLC)among the three groups(P >0.05),however,there were significant differences in the levels of cholesterol(TC),triglyceride(TG),low density lipoprotein(LDLC),apolipoprotein A1(ApoA1),apolipoprotein B(ApoB)and lipoprotein(a)[Lp(a)]between group A and group C(P<0.05).Moreover,there were no significant differences between group B and group C as well as between group B and group A(P >0.05).After treatment,there were significant difference in the levels of TSH,TC,TG,LDLC,ApoA1,Apo B and Lp(a)in group B and group C,as compared to those before treatment(P<0.05),but there were no significant differences in the levels of TSH,TC,TG,LDLC,ApoA1,ApoB and Lp(a)in group A,as compared to those before treatment(P<0.05).Conclusion Levothyroxine can improve thyroid function,and lower lipid levels to some degree.However its differential roles in treating patients with different types of hypothyroidism and in improving lipid metabolism need to be investigated further.

关 键 词：甲状腺功能减退 左旋甲状腺素 脂代谢 

分 类 号：R581.2[医药卫生—内分泌]