甲状腺功能亢进患者血清甲状腺激素水平与动脉粥样硬化相关因子关系分析

The relationship of the levels of FT_3,FT_4,TSH and atherosclerosis related factors of patients with hyperthyroidism

目的 分析甲状腺功能亢进（甲亢）患者游离三碘甲腺原氨酸（FT3）、四碘甲腺原氨酸（FT4）、促甲状腺激素（TSH）水平与动脉粥样硬化相关因子关系。方法 选取2015年1—12月湖北省中西医结合医院内分泌科诊治甲亢患者120例（甲亢组）,选择同期查体健康志愿者100例作为健康对照组,应用经颅多普勒超声及颈动脉超声分析2组颅动脉狭窄、颈动脉狭窄及颈动脉斑块生成情况。同时测定2组血清FT3、FT4、TSH水平、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、非对称甲精氨酸（ADMA）、C反应蛋白（CRP）、血栓素B2（TXB2）、内皮素（ET-1）及一氧化氮（NO）水平。分析血清FT3、FT4、TSH水平与动脉粥样硬化相关因子的关系。结果 甲亢组患者脉络膜前动脉狭窄、颈动脉狭窄及颈动脉斑块发生率显著高于健康对照组（χ^2=93.555、47.324、14.379,P=0.000、0.000、0.000）。甲亢组血清FT3、FT4、TG、LDL-C、IMT、ADMA、CRP、TXB2水平均高于对照组,而TSH、NO水平低于对照组（t=69.634、100.183、49.204、21.817、13.237、11.127、-26.482、-32.853、-31.536、-16.169,P均〈0.05）。经Pearson单因素分析显示：血清FT3、FT4与ADMA、IMT、CRP、TXB2呈正相关（r=0.322、0.302、0.314、0.327和0.305、0.323、0.302、0.336,P均〈0.05）,与NO呈负相关（r=-0.309、-0.325,P=0.000、0.000）,而TSH与ADMA、TXB2呈负相关（r=-0.348、-0.319,P=0.000、0.000）,与LDL-C、NO呈正相关（r=0.326、0.304,P=0.000,0.000）,与其余各指标均未见相关性（P〉0.05）。经Logistic多因素分析显示,甲状腺功能亢进患者血清TSH、LDL-C、ADMA、CRP、TXB2是动脉粥样硬化的独立危险因子,而NO是动脉粥样硬化的保护因子。结论 甲状腺功能亢进可影响机体血脂代谢及促进炎性因子分泌,促进机体动脉粥样硬化改变,是引起动脉粥样硬化的独立危险因子。

Objective To investigate the relationship of the levels of FT 3 , FT4 , TSH and atherosclerosis related fac-tors of patients with hyperthyroidism .Methods One hundred and twenty cases of hyperthyroidism patients and 100 healthy volunteers were selected from January 2015 to December 2015 .The transcranial doppler ultrasound of carotid arteries of two groups were analyzed with cranial artery stenosis , carotid stenosis and carotid artery plaque generation situation .The levels of FT3 , FT4 , TSH, total cholesterol （ TC） , triglyceride （ TG） , low density protein （ LDL-C） , high density protein （ HDL-C） , asymmetric arginine methyl （ADMA）, carotid intima media thickness （IMT）, C reactive protein （CRP）, thromboxane B2 （TXB2）, endothelin （ET-1） and nitric oxide （NO） were determined.The relationship of the levels of FT3, FT4, TSH and atherosclerosis related factors were analyzed .Results The patients with hyperthyroidism cranial artery stenosis , carotid steno-sis and carotid artery plaque incidence were significantly higher than control groups （χ^2 =93.555, χ^2 =47.324, χ^2 =14.379;P =0.000, P =0.000, P =0.000）.The levels of FT3, FT4, TG, LDL-C, IMT, ADMA, CRP, TXB2 of Hyper-thyroidism were higher than control groups （ t =69.634, t =100.183, t =49.204, t =21.817, t =13.237, t =11.127, t =-26.482, t =-32.853, t =-31.536, t =-16.169;P =0.000, P =0.000, P =0.000, P =0.000, P =0.000, P =0 .000, P =0.000, P =0.000, P =0.000, P =0.000）.The FT3, FT4 were positively correlated with ADMA, IMT, CRP, TXB2 （ r =0.322, r =0.302, r =0.314, r =0.327, r =0.305, r =0.323, r =0.302, r =0.336;P =0.000, P =0.000, P =0.000, P =0.000, P =0.000, P =0.000, P =0.000, P =0.000）, and was negatively correlated with NO after Pear-son Univariate analysis （ r =-0.309, r =-0.325;P =0.000, P =0.000）, the TSH were negative correlation with AD-MA, TXB2（ r =-0.348, r =-0.319;P =0.000, P =0.000）, and was positively correlated with LDL-C and NO （ r =0.326, r =0.304;P =0.000, P =0.000）, with the index showed no correlation （ P 〉0.05）.After Logistic multivariate revealed that serum TSH in patients with hyperthyroidism , LDL-C,ADMA, CRP, TXB2 is an independent risk factor for ather-osclerosis, and atherosclerosis is NO protection factor .Conclusion Hyperthyroidism can affect the body＇ s lipid metabolism and promote the secretion of inflammatory cytokines , promote the body atherosclerosis changes caused by atherosclerosis is an independent risk factor .