原发性甲状腺功能减退症与血脂代谢的相关性研究

Research on correlation between primary hypothyroidism and serum lipid metabolism

目的探讨不同程度甲状腺功能减退症和病程对血脂的影响,并观察甲状腺功能减退症患者激素替代治疗后血脂谱的动态变化。方法收集甲状腺功能减退症患者97例,亚临床甲状腺功能减退症32例,中度甲状腺功能减退症28例,重度甲状腺功能减退症37例和31例健康体检者。分别在初诊和激素替代治疗1个月后检测各组血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、总胆固醇(TC)、甘油三酯(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A(ApoA)、载脂蛋白B(ApoB)、脂蛋白(a)[Lp(a)]。通过病史回顾对病程估计的方法确定病程时间。结果不同程度的甲状腺功能减退症对血脂影响不同,重度甲状腺功能减退症组血脂各项均升高,中度甲状腺功能减退症组除TG与HDL-C外均升高,亚甲状腺功能减退症组ApoA与Lp(a)升高。血脂各项与FT3和FT4呈负相关,与TSH呈正相关。甲状腺功能减退症患者激素替代治疗1个月后血脂各项除Lp(a)外其余基本恢复正常。结论甲状腺功能减退症可引起血脂增高,随甲状腺功能减退症程度加重及病程延长,血脂升高越明显,经激素替代治疗后,甲状腺功能减退症病情好转血脂逐渐恢复,血脂可先于甲状腺功能恢复正常。

ObjectiveTo explore the characteristic of serum lipids metabolism under different degrees of hypothyroidism and course, the study observed the dynamic changes in serum lipids metabolism after hormone replacement therapy in patients with hypothyroidism. Methods97 cases of patients with hypothyroidism were collected, 32 patients with subclinical hypothyroidism, 28 patients with moderate hypothyroidism, 37 cases with severe hypothyroidism, and 31 cases of healthy. All patients were examined before and one month after hormone replacement therapy, testing serum free triiodothyronine three （FT3）, free thyroxine （FT4）, thyroid stimulating hormone （TSH）, total cholesterol（TC）, triglyceride（TG）, high density lipoprotein（HDL-C）, low density lipoprotein （LDL-C）, apolipoprotein A（ApoA）, apolipoprotein B（ApoB） and lipoprotein （a）Lp（a）. Results Serum lipids of the severe hypothyroidism group were higher than the control group. TC, LDL-C, ApoA, ApoB and Lp（a） of the moderate hypothyroidism group were higher than the control group. ApoA and Lp（a） of the moderate hypothyroidism group were higher than the control group. The serum lipids were negatively related to FT3 and FT4, and TSH was positively correlated. Different degrees of hypothyroidism had different effects on serum lipids. The more increase course of hypothyroidism, the more obvious increase in the serum lipids level. Hormone replacement therapy in patients with hypothyroidism, the serum lipids returned to be normal after one month except for Lp（a）.ConclusionHypothyroidism can increase serum lipids. The more increase degree and course of hypothyroidism, the more obvious increase in serum lipids level. With the hormone replacement therapy, the serum lipids resumed with hypothyroidism condition improved gradually, serum lipids returned to be normal before the thyroid function.