甲癌根治术后甲减患者血脂水平变化的分析

Study on Changes of Serum Lipid Profile After Withdrawl of Levo-thyroxine Replacement Therapy in Patients with Radical Thyroidectomy for Cancer

目的:分析甲癌根治术后甲状腺功能减退症(甲减)患者停用左旋甲状腺素(LT4)后血脂水平的变化,比较停药后TSH升高达不同程度时血脂水平的差异。方法:46例分化型甲状腺癌(DTC)患者,分别于LT4治疗时和停药后(3～4)周检测血清游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)、超敏促甲状腺素(sTSH)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白AI(ApoAI)、载脂蛋白B(ApoB)、脂蛋白a[LP(a)]。结果:与用LT4治疗时比较,停药(3～4)周后患者血中FT3、FT4降低,sTSH、TC、TG、LDL-C、ApoB、LP(a)升高,差异具有统计学意义(P<0.01),HDL-C、ApoAI差异无统计学意义(P>0.05)。停药后sTSH<50μIU/ml组和sTSH>50μIU/ml组的TC、TG、HDL-C、LDL-C、ApoB、ApoAI、LP(a)差异均无统计学意义(P>0.05)。结论:甲减时血脂水平升高,甲减达一定程度后血脂异常可能并不随TSH升高而加重。

Objective To study the changes of serum lipid profile after withdrawl of levo-thyroxine replacement for 4 weeks in patient with radical thyroidectomy for cancer.Methods Serum thyroid hormones（FT3,FT4,sTSH,with RIA）levels and lipid profile（Total cholesterol,triglycerides,LDL,HDL,apolipoprotein A-I,apolipoprotein B and Lp（a）,with biochemistry）were determined in 46 patients with thyroid carcinoma after operation both during and after 4 weeks＇withdrawl of levo-thyroxine replacement treatment.Results Serum FT3,FT4 levels decreased significantly and serum sTSH,TC,TG,LDL,apo-B,Lp（a）levels increased significantly after 4 weeks＇withdrawl of levo-thyroxine replacement（vs during treatment,P〉 0.01）with no significant changes in HDL and apo A-I levels.The lipid profile in patients with serum sTSH higher than 50μIU/ml（n = 30）was not significantly different from those in patients with serum sTSH below 50μIU/ml（n = 16）（P〉 0.05）.Conclusion Hyperlipidemia did develop in the hyprothyroid patients after withdrawl of levo-thyroxine replacement but the degree of which did not not necossarily correlate with the increment of sTSH levels.