老年亚临床甲状腺功能减退症血脂水平及颈动脉内膜中层厚度的研究

Serum lipid level and carotid intima-media thickness in the elderly with subclinical hypothyroidism

目的探讨亚临床甲减对血脂及动脉粥样硬化的影响。方法纳入225例60岁及以上体检人群,按甲状腺功能状态分为亚临床甲减组65例,甲状腺功能正常组190例;测定两组促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、总三碘甲状腺原氨酸(TT3),游离甲状腺素(FT4)、总甲状腺激素(TT4)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、颈动脉内膜中层厚度(CIMT)平均厚度等。比较两组血脂水平及CIMT,并分析TSH与TC、LDL-C、CIMT的独立相关性。结果亚临床甲减组与甲状腺功能正常组相比,年龄、性别比差异无统计学意义(P> 0. 05);亚临床甲减组TC、LDL-C、脂蛋白a[Lp(a)],高于甲状腺功能正常组(P <0. 05);高密度脂蛋白脂蛋白(HDL-C)低于甲状腺功能正常组(P <0. 05);亚临床甲减组内膜中层厚度(IMT)高于甲状腺功能正常组。两组体质指数(BMI)、Apo-A1、载脂蛋白B(Apo-B)、三酰甘油(TG)差异无统计学意义(P> 0. 05)。Pearson相关分析显示TSH值与TC、LDL-C、CIMT成正相关(r=0. 202、0. 472、0. 365,P均<0. 05),与BMI、HDL-C、TG、Apo-A无明显相关。结论老年亚临床甲减患者存在脂代谢异常并且是动脉粥样硬化高危人群,存在心血管疾病高风险。

Objective To explore the effect of subclinical hypothyroidism on blood lipid and atherosclerosis.Methods 225 cases aged 60 years or above were included in the physical examination group,then divided into subclinical hypothyroidism group( 65 cases) and normal thyroid function group( 190 cases) according to thyroid function state. Thyroid-stimulating hormone( TSH),free triiodothyronine( FT3),total triiodothyronine( TT3),free thyroxine( FT4),total thyroid hormone( TT4),total cholesterol( TC),low-density lipoprotein Cholesterol( LDL-C),mean thickness of carotid intima-media thickness( CIMT),etc. were determined. The blood lipid level and CIMT were compared between the two groups,and the correlation between TSH and TC,LDL and CIMT was analyzed. Results There were no significant difference in age,sex ratio,body mass index( BMI) between subclinical hypothyroidism group and normal thyroid function group( P > 0. 05). The levels of TC,LDL-C,lipoprotein a in subclinical hypothyroidism group were higher than those in normal thyroid function group( P < 0. 05). High-density lipoprotein( HDL-C) was lower than that in normal thyroid function group( P < 0. 05). IMT of subclinical hypothyroidism group was higher than normal thyroid function group. There were no significant difference in BMI,apo-A1,apo-B,triglyceride( TG) between the two groups( P >0. 05). Pearson correlation analysis showed that TSH values was positively correlated with TC,LDL-C,and CIMT( r =0. 202,0. 472,0. 365,P < 0. 05). There was no significant correlation between TSH values and BMI,HDL-C,TG,and lipoprotein A. Conclusion Elderly patients with subclinical hypothyroidism have abnormal lipid metabolism and are at high risk for atherosclerosis cardiovascular disease.