甲状腺功能变化可能是结节性甲状腺肿伴发胆囊结石的发病始动因素

The changes of thyroid function may be the originating etiologic factor of nodular goiter accompanied with gallstone

目的:研究甲状腺功能变化和胆固醇水平与结节性甲状腺肿伴发胆囊结石的关系。方法:采集超声检查结合手术确诊的结节性甲状腺肿伴发胆囊结石患者120例、单纯结节性甲状腺肿128例和健康对照组50例的外周静脉血,采用电化学发光法检测其促甲状腺激素(TSH)、总三碘甲状腺原氨酸(TT3)和总甲状腺素(TT4)水平,酶法测定血清总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和血清总胆汁酸(TBA)水平,观察3组之间甲状腺功能变化和胆固醇水平。结果:结节性甲状腺肿伴发胆囊结石组、单纯结节性甲状腺肿TT3水平均显著低于对照组(P<0.01),结节性甲状腺肿伴发胆囊结石组TSH水平显著高于对照组(P<0.01),3组TT4水平差异无统计学意义(P>0.05)。结节性甲状腺肿伴发胆囊结石组TC和LDL-C显著高于单纯结节性甲状腺肿组和对照组(P<0.01),而结节性甲状腺肿伴发胆囊结石组TBA低于单纯结节性甲状腺肿组和对照组(P<0.01)。单纯结节性甲状腺肿组和对照组TC和LDL-C水平差异均无统计学意义(P>0.05),而伴发胆囊结石组和对照组HDL-C水平均明显高于单纯甲状腺肿组(P<0.01)。结论:结节性甲状腺肿伴发胆囊结石的发病始动因素可能是患者TT3降低导致的渐进性亚临床甲状腺功能减退。外源性补充左旋甲状腺激素钠可能防止结节性甲状腺肿伴发胆囊结石的发病。

Objective：To explore the relationship between thyroid function alteration,cholesterol levels and the pathogenesis of nodular goiter accompanied with gallstone.Methods：One hundred and twenty nodular goiter patients accompanied with gallstone,128 simple nodular goiter patients and 50 healthy control cases were collected with ultrasound examination and postoperative pathological diagnosis.The peripheral venous blood of these cases in the three groups were collected and serum thyroid stimulating hormone（TSH）,total triiodothyronine（TT3）,total tetraiodothyronine（TT4）,total cholesterol（TC）,high-density lipoprotein cholesterol（HDL-C）,low-density lipoprotein cholesterol（LDL-C） and total bile acid（TBA） levels were measured by electrochemiluminescence method,and the changes of thyroid function and cholesterol levels were observed among the three groups.Results：The serum TT3 levels in nodular goiter accompanied with gallstone group and the simple nodular goiter group were significantly lower than in control group（P〈0.01）,and TSH levels in the former two groups were significantly higher than in control group（P〈0.01）.There were no significant difference of TT4 levels among the three groups（P〉0.05）.Accordingly,TC and LDL-C levels in nodular goiter accompanied with gallstone group were significantly higher,while TBA levels were significantly lower than in simple nodular goiter group and control group（P〈0.01）.The levels of TC and LDL-C had no statistical difference between simple nodular goiter group and control group（P〉0.05）.The HDL-C level in nodular goiter accompanied with gallstone group was higher than in simple nodular goiter group.Conclusions：The originating etiologic factor of nodular goiter accompanied with gallstone may be that the decreased TT3 induced progressive subclinical hypothyroidism.Exogenous L-thyroxine sodium salt supplement maybe prevent the pathogenesis of nodular goiter accompanied with gallstone.