脑梗死合并亚临床甲状腺功能减退与内脂素及内皮素的关系

Correlation of visfatin and endothelin with subclinical hypothyroidism in patients with cerebral infarction

目的脑梗死患者中关于亚临床甲状腺功能和内脂素、内皮素关系的研究较少。文中旨在探讨脑梗死合并亚临床甲状腺功能减退(简称甲减)患者甲状腺功能与内脂素、内皮素的关系。方法入选2011年1月至2017年7月海南医学院第二附属医院内分泌科及老年病科脑梗死患者200例。将其分为4组:对照组[脑梗死合并甲状腺功能正常,促甲状腺激素(TSH)、游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)均正常,n=40]、轻度亚临床甲减组(4≤TSH<10 m IU/L,FT3、FT4正常,n=60)、重度亚临床甲减组(TSH≥10 m IU/L,FT3、FT4正常,n=60)、临床甲减组(TSH≥4 m IU/L,FT3、FT4降低,n=40)。其中轻度亚临床甲减组随机分为轻度服药亚组、轻度未服药亚组;重度亚临床甲减组患者随机分为重度服药亚组、重度未服药亚组,每组30例。2个服药组在常规治疗基础上加用左甲状腺素片;2个未服药组采用常规治疗。记录所有患者年龄、性别、BMI、血压、血糖、血脂、甲状腺功能等,比较患者内脂素、内皮素的差异。结果重度亚临床甲减组、临床甲减组内脂素含量[(46.3±10.1)、(49.5±13.6)ng/m L]较对照组[(40.2±9.7)ng/m L]明显升高(P<0.05)。重度服药亚组6个月时内脂素较重度未服药亚组升高[(42.9±6.4)ng/m L vs(39.3±5.5)ng/m L,P<0.05]。结论相对于甲状腺功能正常的脑梗死患者,重度亚临床甲减合并脑梗死患者与内脂素关系更密切。对脑梗死患者应积极筛查甲状腺功能,及早发现和干预重度亚临床甲减非常必要。

Objective Few studies are reported on the relationship of subclinical hypothyroidism （ SCHT ） with visfatin and endothelin .This study aimed to investigate their relationship in patients with cerebral infarction . Methods A total of 200 cerebral in-farction patients treated in The Second Affiliated Hospital of Hainan Medical University from January 2011 to July 2017 were divided in-to a control （ with normal thyroid function , n=40 ） , a mild SCHT （ with thyroid-stimulating hormone TSH 〈10 mIU/L, normal free triiodothyronine FT3 and normal free thyroxine FT4, n=60）, a se-vere SCHT （with TSH≥10 mIU/L, normal FT3 and normal FT4, n=60） , and a clinical hypothyroidism （ CHT ） group （ with TSH ≥4 mIU/L, decreased FT3 and decreased FT4, n=40）.The mild SCHT patients were subdivided into medication group A and non-medication group A, and the severe SCHT patients into medication group B and non-medication group B, 30 in each group, those in the medica-tion groups A and B treated by routine therapy plus oral levothyrocine , and those in the non-medication groups A and B by routine ther-apy only.We recorded the age, gender, body mass index, blood pressure, blood glucose, blood lipid, and thyroid function of the pa-tients, and compared the levels of visfatin and endothelin among different groups . Results The level of visfatin was significantly ele-vated in the severe SCHT and CHT groups as compared with the controls （[46.3±10.1] and [49.5±13.6] vs [40.2±9.7] ng/mL, P〈0.05）, and so was it in medication group B as compared with non-medication group B at 6 months after treatment （[42.9±6.4] vs [39.3±5.5] ng/mL, P〈0.05）. Conclusion Visfatin is closely related with thyroid hormone in cerebral infarction patients with se -vere subclinical hypothyroidism .Examination of thyroid function is necessary for cerebral infarction patients for the sake of early detec -tion of severe subclinical hypothyroidism and timely intervention .