脑梗死合并亚临床甲状腺功能减退病人24 h尿蛋白及血同型半胱氨酸水平分析  

Serum levels of 24-hour urinary protein and homocysteine in patients with cerebral infarction complicated with subclinical hypothyroidism

作　　者：符沙沙 陈宗存[2] 欧宗兴[3] 周晓莉[1] 陈小庄[1] FU Sha-sha;CHEN Zong-cun;OU Zong-xing;ZHOU Xiao-li;CHEN Xiao-zhuang(Department of Gerontology,Hainan General Hospital,Haikou 570311,China;Department of Endocrinology,the Second Affiliated Hospital of Hainan Medical University,Haikou 570311,China;Department of Respiratory Medicine,Haikou Hospital Affiliated to Xiangya Medical College,Central South University,Haikou 570208,China)

机构地区：[1]海南省人民医院老年病科,海南省海口市570311 [2]海南医学院附属第二医院内分泌科,海南省海口市570311 [3]中南大学湘雅医学院附属海口医院呼吸内科,海南省海口市570208

出　　处：《实用老年医学》2019年第4期355-358,共4页Practical Geriatrics

基　　金：海南省自然科学基金(817386);海南省医药卫生科研项目(1301000320A1005);海南省卫生计生行业科研项目(16A200071)

摘　　要：目的探讨脑梗死合并亚临床甲状腺功能减退(亚甲减)病人甲状腺功能与24 h尿蛋白、血同型半胱氨酸的关系。方法入选2011年1月至2017年7月海南省人民医院老年病科脑梗死病人200例。按甲状腺功能将其分为4组:对照组40例[脑梗死合并甲状腺功能正常,即游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)及促甲状腺激素(TSH)均正常]、轻度亚临床甲减组60例(FT3、FT4正常,4 m IU/L≤TSH<10 m IU/L)、重度亚甲减组60例(FT3、FT4正常,TSH≥10 m IU/L)、临床甲减组40例(FT3、FT4降低,TSH≥4 m IU/L)。其中轻度亚甲减组及重度亚甲减组的病人均分别再随机分为服药亚组和未服药亚组,各亚组均为30例。2个未服药亚组采用常规治疗,2个服药亚组加用左甲状腺素片治疗6个月。记录病人的年龄、性别、血压、血糖、血脂、甲状腺功能等,比较4组24 h尿蛋白、血同型半胱氨酸水平的差异。结果 4组病人年龄、性别、血压、血糖、血脂差异无统计学意义(P>0. 05)。脑梗死合并重度亚甲减组、临床甲减组24 h尿蛋白水平较对照组明显升高(P<0. 05)。重度亚甲减服药亚组6个月时24 h尿蛋白、同型半胱氨酸水平较重度亚甲减未服药亚组降低(P<0. 05)。结论对脑梗死病人应积极筛查甲状腺功能,及早发现和干预重度亚甲减,以减少肾损害和心脑血管疾病风险。Objective To explore the relationship of thyroid function with 24-hour urinary protein(24hUP)and homocysteine(Hcy)in the patients with cerebral infarction complicated with subclinical hypothyroidism(SCHT).Methods A total of 200 patients with cerebral infarction in the Department of Geriatrics of Hainan General Hospital from January 2011 to July 2017 were enrolled.The patients were divided into four groups:control group[with normal levels of three free iodine thyroid original glycine(FT3),free thyroxine(FT4)and thyroid-stimulating hormone(TSH),40 cases],mild SCHT group(4 mIU/LTSH<10 mIU/L,normal levels of FT3 and FT4,60 cases),severe SCHT group(TSH≥10 mIU/L,normal levels of FT3 and FT4,60 cases),and clinical hypothyroidism(CHT)group(TSH≥4 mIU/L,the levels of FT3 and FT4 decreased,40 cases).The mild SCHT group and severe SCHT group were randomly subdivided into medication group and non-medication group respectively,with 30 cases in each group.The patients in the medication group were treated with routine therapy and oral levothyrocine for 6 months,and those in the non-medication group were treated with routine therapy only.The age,gender,blood pressure,blood glucose,blood lipids,and the level of thyroid function of the patients were recorded,and the levels of 24hUP and Hcy were detected and compared among different groups.Results There were no significant differences in age,gender,blood pressure,blood glucose and blood lipids among the four groups(P>0.05).The levels of 24hUP and Hcy were significantly increased in severe SCHT group and CHT group than those in control group(P<0.05).The levels of 24hUP and Hcy in severe SCHT medication group were significantly lower than those in severe SCHT non-medication group(P<0.05).Conclusions It is important for the patients with cerebral infarction to detect the level of thyroid function and intervene promptly,which could help to decrease the risk of renal injury and cardio-cerebrovascular disease.

关 键 词：脑梗死 亚临床甲状腺功能减退 24h尿蛋白 同型半胱氨酸 

分 类 号：R743.32[医药卫生—神经病学与精神病学] R582.2[医药卫生—临床医学]