TPOAb增高的原发性甲状腺功能减退患者心肌酶谱水平的变化特点

The changes of myocardial enzyme levels in patients with primary hypothyroidism and increase of TPOAb

目的探讨甲状腺过氧化物酶抗体(TPOAb)升高的原发性甲状腺功能减退症(甲减)患者心肌酶谱水平的变化。方法选择2013年1月—2017年12月在江苏省泗洪县人民医院门诊首诊的89例原发性甲减患者作为研究对象,根据TPOAb检测结果分为两组,其中42例TPOAb升高者为TPOAb阳性组(TPOAb>13 U/mL),47例TPOAb水平正常者为TPOAb阴性组(TPOAb为0~13 U/mL)。分别检测两组患者空腹时的心肌酶谱,包括肌酸激酶(CK)及其同工酶(CK-MB)、乳酸脱氢酶(LDH)、α-羟丁酸脱氢酶(α-HBDH)、天冬氨酸转氨酶(AST)及其同工酶(ASTm)、缺血性修饰白蛋白(IMA),并进行比较及相关性分析。结果 TPOAb阳性组患者的心肌酶谱CK、CK-MB、LDH、IMA和α-HBDH水平较TPOAb阴性组均明显升高[CK(U/L):320.0±40.6比220.0±30.2,CK-MB(U/L):28.3±6.3比17.6±3.5,LDH(U/L):356.0±45.2比298.0±30.2,IMA(U/mL):200.6±36.5比125.2±20.3,α-HBDH(U/L):280.0±32.6比220.0±23.6,均P<0.05];两组患者的AST、ASTm水平比较差异均无统计学意义(均P>0.05)。相关性分析显示,TPOAb与CK(r=0.75,P=0.000)、LDH(r=0.36,P=0.035)、IMA(r=0.72,P=0.000)呈正相关;TPOAb阳性组甲减患者更易出现心率减慢、心肌间质黏液水肿、心肌炎、乏力嗜睡等症状。结论 TPOAb升高的原发性甲减患者血清心肌酶谱水平明显升高,二者相互影响可加重病情。

Objective To investigate the changes in myocardial enzyme spectrum for patients with primary hypothyroidism and elevation of thyroid peroxidase antibody（TPOAb） level. Methods From January 2013 to December 2017, 89 patients with primary hypothyroidism were firstly diagnosed and studied in the Outpatient Department of Sihong County People＇s Hospital in Jiangsu Province. According to the results of TPOAb detection, the patients were divided into two groups： TPOAb positive group and TPOAb negative group, there were 42 cases positive with their TPOAb level higher than normal（TPOAb 13 U/mL）, and there were 47 cases negative with TPOAb level in normal range（TPOAb was 0-13 U/mL）. Myocardial enzyme spectrum was detected under fasting situation in the two groups, including creatine kinase（CK） and its isoenzyme（CK-MB）, lactic dehydrogenase（LDH）, α-hydroxybutyrate dehydrogenase（α-HBDH）, aspartate transaminase（AST） and its isoenzyme（ASTm）, ischemic modified albumin（IMA）, and the results in the two groups were compared and the correlation analyses were carried out. Results Compared to the normal group,the levels of CK, CK-MB, LDH, IMA, and α-HBDH in the positive group were obviously increased [CK（U/L）： 320.0±40.6 vs. 220.0±30.2, CK-MB（U/L）： 28.3±6.3 vs. 17.6±3.5, LDH（U/L）： 356.0±45.2 vs. 298.0±30.2, IMA（U/mL）： 200.6±36.5 vs. 125.2±20.3, α-HBDH（U/L）： 280.0±32.6 vs. 220.0±23.6, all P〈0.05]. There were no statistical significant differences between the AST and m-AST levels in the two groups（all P〈0.05）. Correlation analyses showed that the TPOAb is positively correlated with CK（r = 0.75, P = 0.000）, LDH（r = 0.36, P = 0.035） and IMA（r = 0.72, P = 0.000） respectively. Besides, patients in positive group were easier to have a decreased heart rate, myocardial myxedema, myocarditis and lethargy, etc symptoms and signs. Conclusion The level of serum myocardial enzyme is obviously increased in primary hypothyroidism with increased TPOAb, and these 2 factors mutually influencing each other may aggravate the disease situation.