亚临床甲状腺功能减退症患者促甲状腺素水平与血脂的关系研究

Study on the Relationship between Thyroid Stimulating Hormone and Lipid Profiles in Patients with Subclinical Hypothyroidism

目的探讨亚临床甲状腺功能减退症(甲减)患者促甲状腺激素(TSH)与血脂水平的关系。方法回顾性分析2010年1月-2014年1月264例初次诊断为亚临床甲减未经治疗者(按TSH≥10 m U/L与3.6 m U/L≤TSH<10.0 m U/L分组),并选择社区健康对照人群288例,收集所有研究对象的肝功能、肾功能、血脂、甲状腺功能、甲状腺过氧化物酶抗体(TPO-Ab),探讨TSH水平与血脂的关系。结果 3组三酰甘油(TG)、高密度脂蛋白胆固醇水平差异无统计学意义(P>0.05)。TSH≥10 m U/L组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平分别为(5.93±1.12)、(3.82±1.11)mmol/L,明显高于对照组[分别为(4.43±1.12)、(2.66±0.43)mmol/L],差异均有统计学意义(P<0.05);而在3.6 m U/L≤TSH<10.0 m U/L组TC、TG、LDL-C与对照组相比有升高趋势,但差异无统计学意义(P>0.05)。112例TPO-Ab阳性的亚临床甲减患者在12周甲状腺激素替代治疗后TC、LDL-C、TC水平[分别为(4.62±1.03)、(2.97±0.52)、(1.17±0.62)mmol/L]较治疗前[分别为(5.43±1.18)、(3.62±0.58)、(2.03±0.71)mmol/L]均有明显下降,差异均有统计学意义(P<0.05)。结论亚临床甲减患者存在明显的血脂代谢紊乱,特别是TSH≥10 m U/L是血脂异常的高危因素,对于TPO-Ab阳性的患者进行甲状腺素替代治疗可有效改善亚临床甲减患者的血脂异常,可能是经济有效地改善血脂代谢紊乱的有效措施。

Objective To investigate the relationship between thyroid stimulating hormone （TSH） and the blood lipid level in patients with subclinical hypothyroidism （SCH）. Methods We carried out a retrospective analysis on the clinical data of 264 patients with their first diagnosis of subclinical hypothyroidism without treatment from 2010 January to 2014 January. A total of 288 healthy controls were chosen from communities. The patients were groups based on TSH ≥ 10.0 mU/L and 3.6 mU/L ≤ TSH 〈 10.0 mU/L. We investigated the relationship between TSH and the level of blood lipids by analyzing liver and renal function, blood lipids, thyroid function, and thyroid peroxidase antibody （TPO-Ab） in the patients. Results Triglyceride （TG） and high density lipoprotein cholesterol levels were not significantly different among the three groups （P 〉 0.05）. Total cholesterol （TC） and low density lipoprotein cholesterol （LDL-C） levels of the group with TSH ≥ 10 mU/L were respectively （5.93±1.12） and （3.82±1.11） mmol/L, which were significantly higher than those in the controls [（4.43±1.12） and （2.66±0.43） mmol/L] （P 〈 0.05）. TC, TG and LDL-C levels of the group with 3.6 mU/L ≤ TSH 〈 10.0 mU/L were higher than the controls, but the differences were not significant （P 〉 0.05）. After thyroid hormone replacement therapy within 12 weeks, TG, LDL-C, and TC levels of TPO-Ab positive patients with subclinical hypothyroidism （n=112） were respectively （4.62±1.03）, （2.97±0.52）, and （1.17±0.62） mmol/L, which were significantly lower than those levels before treatment [（5.43±1.18）, （3.62±0.58）, and （2.03±0.71） mmol/L] （P 〈 0.05）. Conclusions The disorder of lipid metabolism exists in patients with subclinical hypothyroidism.