亚临床甲状腺功能减退症与冠心病及其危险因素的相关性研究

Correlation of subclinical hypothyroidism with coronary heart disease and its risk factors

目的 探讨亚临床甲状腺功能减退症（甲减）与冠心病及其危险因素的相关性.方法 对2013年11月-2014年12月于吉林大学中日联谊医院住院的313例行冠状动脉造影的患者进行临床资料收集,根据甲状腺功能（甲功）将患者分为亚临床甲减组（82例）及甲功正常组（231例）.收集患者的临床资料,检测甘油三酯、总胆固醇、高密度脂蛋白-胆固醇（HDL-C）、低密度脂蛋白-胆固醇（LDL-C）、空腹血糖、血白蛋白、血清总胆红素、血尿素氮、血肌酐、游离T4、游离T3、促甲状腺激素（TSH）水平,并进行心脏彩色超声检测,测定左心室舒张末期内径及射血分数.结果 （1）亚临床甲减组甘油三酯水平、LDL-C水平及患糖尿病的比例均高于甲功正常组,而血清总胆红素水平低于甲功正常组（t=4.245,3.046,2.042,P均＜0.05;χ^2=12.020,P=0.001）.（2）亚临床甲减组左心室舒张末期内径、射血分数均低于甲功正常组（t=4.529,2.049,P均＜0.05）.（3）亚临床甲减组冠心病的发生率显著高于甲功正常组（χ^2=10.588,P=0.001）.（4）多因素分析发现冠心病、甘油三酯、LDL-C、糖尿病、左心室舒张末期内径均与亚临床甲减具有相关性[优势比（OR） =6.367,6.311,1.606,2.430,0.312,P均＜0.01].结论 亚临床甲减与冠心病、甘油三酯、LDL-C、糖尿病、左心室舒张末期内径有关.对于冠心病、高血脂及糖尿病患者,定期监测甲功具有重要的临床意义.

Objective To investigate the correlation of subclinical hypothyroidism with coronary heart disease and its risk factors.Methods A total of 313 hospitalized patients undertaken coronary angiography were selected in China-Japan Union Hospital of Jilin University from Nov 2013 to Dec 2014.According to the thyroid function,patients were divided into subclinical hypothyroidism group （82 cases） and normal thyroid function group （231 cases）.Clinical data of patients were collected.Triglyceride,total cholesterol,high density lipoprotein cholesterol （HDL-C）,low density lipoprotein cholesterol （LDL-C）,fasting blood glucose,blood serum albumin,total bilirubin,blood urea nitrogen,blood creatinine,free thyroxine,free triiodothyronine and thyroid stimulating hormone （TSH） were detected.Cardiac ultrasound was used to detect left ventricular end diastolic diameter and ejection fraction.Results （1） The levels of triglyceride,LDL-C,as well as the percentage of diabetes in subclinical hypothyroidism group were higher than those in normal thyroid function group,while serum total bilirubin level was lower than that in normal thyroid function group （t =4.245,3.046,2.042,all P 〈 0.05;χ^2 =12.020,P =0.001）.（2） Both left ventricular end diastolic diameter and ejection fraction in subclinical hypothyroidism group were less than those in normal thyroid function group（t =4.529,2.049,all P 〈 0.05）.（3） The incidence of coronary heart disease in subclinical hypothyroidism group was significantly higher than that in normal thyroid function group （χ^2=10.588,P=0.001）.（4） Multivariate analysis showed triglyceride,LDL-C,diabetes,coronary heart disease,left ventricular end diastolic diameter were related to subclinical hypothyroidism （odd ratio =6.367,6.311,1.606,2.430,0.312,all P〈0.01）.Conclusions Subclinical hypothyroidism correlates with coronary heart disease,triglyceride,LDL-C,diabetes and left ventricular end diastolic diameter.It has important clinical significance for regularly monitoring thyroid function in patients with coronary heart disease,hyperlipidemia and diabetes.