左甲状腺素联合阿托伐他汀治疗对甲减患者血脂的影响

Effects of L-T4 replacement or with Atorvastatin treatment on lipid profiles in patients with primary hypothyroidism

目的:观察新诊断的原发性甲状腺功能减退症(甲减)患者血脂谱特点;采用单纯左甲状腺素替代及联合阿托伐他汀治疗并动态观察血脂改变。方法:58例新诊断的甲减患者给予左甲状腺素(L-T4)替代治疗3个月后随机分为单纯替代治疗组(L-T4组)及联合阿托伐他汀(10mg/d)治疗组(阿托伐他汀组),每3个月复查患者的甲状腺功能(包括游离甲状腺素、游离三碘腺原氨酸及促甲状腺素)、血脂指标(包括甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇)及谷丙转氨酶、肌酸激酶的变化。结果:L-T4替代治疗3个月后两组血游离甲状腺素、游离三碘腺原氨酸水平明显上升至正常范围,而促甲状腺素显著下降(P<0.05);患者存在明显的高总胆固醇、低密度脂蛋白胆固醇血症;L-T4组在第6个月总胆固醇及低密度脂蛋白胆固醇仍呈高水平;阿托伐他汀组在第6个月总胆固醇、低密度脂蛋白胆固醇明显降低(P<0.05),并在观察期间维持稳定。观察期间两组谷丙转氨酶、肌酸激酶水平均正常且无显著差别(P>0.05)。结论:甲减患者存在显著的高胆固醇血症;单纯左甲状腺素替代治疗难以改善血脂异常,而联合阿托伐他汀治疗有助于长期维持血脂正常和稳定。

Objective.. To investigate the alteration of serum lipid profiles in newly diagnosed patients with pri- mary hypothyroidism. Effects of levothyroxine（L-T4） replacement alone or with Atorvastatin （Atorva） treatment on lipid profiles were prospectively followed during a 15-month period. Method.. Soon after replacement with L-T4 for 3 months, fifty-eight patients with newly diagnosed hypothyroidism were randomly dispatched into single L-T4 or L-T4 with Atorva treatment group. All corresponding laboratory indexes were repeated every 3 months such as thyroid function parameters including free thyroxine （FT4）, free triiodothyronine （FT3） and thyroid stimulating hormone（TSH）, lipid profiles including triglyceride （TG）, total cholesterol （TC）, low-density lipoprotein choles- terol （LDL-C）, and high-density lipoprotein cholesterol （HDL-C）, as well as creatine kinase （CK） and alanine aminotransferase （ALT）. Result.. Serum FT4 and FT3 in all patients rose into their normal ranges while TSH fell significantly （P〈0.05） after the initial 3-month L-T4 treatment. All recruited patients showed remarkably high levels of TC and LDL-C. The initial replacement with L-T4 for 3 months did not lower serum TC and LDL-C sig- y, while thyroid hormone replacement combined with Atorva for 3 months definitely decreased these two ers （P〈0.05） and kept them constant until the end of this study. Serum ALT and CK were both in nor- mal range and comparable （P〉0.05） between two treatment groups during the study. Conclusion： Hypercholes- terolemia is common in primary hypothyroidism. L-T4 replacement with statins may effectively and permanently normalize lipid profiles in these patients, while L-T4 alone exerts minor effects on dyslipidemia.