激素替代治疗对甲状腺功能减退症患者血管内皮舒张功能的改变

Change of vascular endothelium diastolic function in patients with hypothyroidism treated by hormone replacement therapy

目的探讨激素替代治疗对甲状腺功能减退症患者血管内皮舒张功能的改变。方法选取2009年1月至2016年7月在昌乐县人民医院诊治的34例甲状腺功能减退症患者作为观察组,观察组患者给予左旋甲状腺素50～150μg/d替代治疗,在患者促甲状腺激素(TSH)水平恢复正常后,继续维持治疗3个月,然后复查血脂指标和甲状腺功能,均空腹采血。选取46例同期健康体检者作为对照组。结果与对照组比较,在治疗前观察组患者的TSH高于对照组;在治疗后观察组患者的TSH水平降低,游离三碘甲腺原氨酸(FT3)和游离甲状腺素(FT4)升高。与对照组比较,在治疗前观察组患者的总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)的水平高于对照组;在治疗后观察组患者的TC,TG,LDL-C水平降低,差异均具有统计学意义(P<0.05)。在治疗前观察组患者血流介导的血管舒张功能低于对照组;治疗后与治疗前比较,血流介导的血管舒张功能升高,差异均有统计学意义(P<0.05)。观察组患者治疗前后的硝酸甘油诱导的血管舒张功能比较,差异无统计学意义(P>0.05)。结论观察组患者经激素替代治疗血管内皮依赖性舒张功能减低,可以改善其血管内皮功能。

Objective To investigate the effect of hormone replacement therapy on vasodilatation in patients with hypothyroidism. Methods From January 2009 to July 2016, 34 patients with hypothyroidism were treated as the observation group. In the observation group, 50-150 μg/d replacement therapy of L-thyroxine was given. After the level of thyroid stimulating hormone（TSH） returned to normal, the patients continued to be treated 3 months, and then review the lipid index and thyroid function, patients tested fasting blood. 46 healthy subjects were selected as the control group. Results Compared with the control group, TSH in the observation group was higher than that in the control group before treatment. After treatment, the TSH level of the observation group decreased, the free triiodothyronine（FT3） and the free thyroxine（FT4） increased. Compared with the control group, the levels of total cholesterol（TC）, triacylglycerol（TG） and low density lipoprotein-cholesterol（LDL-C） in the observation group were all higher than those in the control group before treatment and they were all decreased after treatment. All the differences were statically significant（P〈0.05）. The blood flow-mediated vasodilatation in the observation group was lower than that in the control group before treatment, and the blood flow-mediated vasodilatation was significantly improved after treatment（P〈0.05）. There was no significant difference in the vasodilatation induced by nitroglycerin before and after treatment（P〈0.05）. Conclusions Vascular endothelium-dependent diastolic function is reduced by hormone replacement therapy in the observation group, which can improve the vascular endothelial function.