老年患者甲状腺功能与动脉硬化及心功能的相关性分析

The changes of thyroid function in the elderly and correlation of the changes with atherosclerosis and cardiac function

目的探讨老年患者中甲状腺功能紊乱及其与动脉粥样硬化和心功能的关系。方法随机选取2013年1月至2015年5月在兰州大学第一医院老年病房的住院患者I973例，对其中符合纳入标准的472例患者的甲状腺功能的检查结果及其临床资料进行了总结分析。结果（1）甲状腺功能减退（甲减）及亚甲减的检出率为48．5％，随年龄的增长而逐渐增加（Х^2=30．63，P％0．01）；甲状腺功能亢进（甲亢）的检出率仅为1．9％，随年龄的增长无显著变化（（Х^2=5．46，P〉0．05）。甲状腺素（TT3）、TT4及促甲状腺激素（TSH）均呈现增龄性改变（F值依次为11．782、5．061、2．851，均P〈0．05）。（2）甲减组的年龄、舒张压、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、同型半光氨酸水平均高于甲功正常组（F值分别为18．149、4．576、5．248、5．472、4．318、3．752、11．884，均P〈0．05）。（3）TSH值与颈一股动脉脉搏波速度（C-FPWV）值、脉冲多普勒二尖瓣E峰与组织多普勒二尖瓣环E’峰之比值（E／E’）值、血浆氨基末端脑钠肽前体（NT-proBNP）值呈正相关（r值分别为0．609、0．118、0．185，P〈0．05），而与左心室射血分数（LVEF％）则未见明显相关性（r=0．030，P〉0．05）。结论在老年患者中，甲状腺激素水平呈增龄性改变，甲减及亚甲减的患病率高且亦随年龄而增加。甲状腺功能减退会增加动脉粥样硬化以及心脏舒张功能减低的患病风险。

Objective To investigate the changes of thyroid function in the elderly and correlation of the changes with atherosclerosis and cardiac function. Methods The 1 973 inpatients were randomly selected in the First Hospital of Lanzhou University from January 2013 to May 2015. A total of 472 patients of the 1 973 inpatients meeting the inclusive criteria received thyroid function testing, and their correlated clinical data were collected for analysis. Results （1）The prevalence of overt and subclinical hypothyroidism was 48. 5% and increased along with ageing（Z= 30. 63, P~ 0. 01）. However, the detection rate of hyperthyroidism was only 1.9% and there was no significant association between the detection rate of hyperthyroidism and ageing（Z= 5.46, P〈0. 05）. The levels of TT3, TT4 and TSH changed with ageing（F =11. 782,5. 061 and 2. 851 ,each P〈0.05）. （2）Age,diastolic BP,serum TC,TG,LDL-C and homocysteine level were significantly higher in the hypothyroidism group than in the control group（F= 18. 149,4. 576, 5. 248,5. 472,4. 318, 3. 752, and 11. 884, each P%0. 05）. （3） TSH level was positively related with C- FPWV, E/E＇, NT-proBNP （ r = 0. 609,0.118,0. 185, each P 〈 0. 05 ）, while no significant association was observed between TSH and LVEF% （r = 0. 030, P 〈 0.05 ）. Conclusions The elderly patients show a change in the serum levels of TSH and thyroid hormones with ageing. And the prevalence of overt and subclinical hypothyroidism is obviously increased along with ageing. Hypothyroidism is the risk factor for atherosclerosis and cardiac diastolic dysfunction.