冠心病合并亚临床甲减患者冠状动脉狭窄程度与内皮功能损伤的相关性

Correlation between the degree of coronary artery stenosis and endothelial dysfunction in patients with coronary heart disease and subclinical hypothyroidism

目的探讨冠心病合并亚临床甲状腺功能减退(亚临床甲减)患者冠状动脉狭窄与血管内皮损伤的相关性。方法根据冠状动脉造影检查及甲功结果,分为冠心病合并亚临床甲减组(A组,n=71)、冠心病无亚临床甲减组(B组,n=73)以及冠脉造影正常组(对照组,n=59),用Gensini积分法评估冠状动脉狭窄程度。抽取空腹血测定一氧化氮(NO)、超敏C反应蛋白(hs-CRP)、内皮素(ET)水平评价内皮功能损伤情况。结果3组间比较,总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-c)、游离三碘甲状腺原氨酸(FT3)、促甲状腺素(TSH)、hs-CRP、ET和Gensini评分,A组高于B组及对照组(P<0.05);A组和B组NO水平低于对照组(P<0.05)。多因素Logistic回归分析结果显示:年龄、TSH、ET、NO为冠心病的独立危险因素。冠心病合并亚临床甲减组患者ET、NO水平与Gensini评分相关(r=0.431,r=-0.383,P<0.001)。结论亚临床甲减可能引起冠心病患者血管内皮紊乱,从而可能增加冠心病患者心血管风险。

Objective To study the correlation between coronary artery stenosis and endothelial dysfunction in patients with coronary heart disease and subclinical hypothyroidism.Methods According to the results of coronary angiography and thyroid function,the patients were divided into coronary heart disease with subclinical hypothyroidism（group A,n=71）,coronary heart disease without subclinical hypothyroidism（group B,n=73）,and normal coronary angiography（control group,n=59）.The degree of coronary artery stenosis was evaluated by Gensini integral method.Fasting blood was taken to measure nitric oxide（NO）,high sensitivity C reactive protein（hs-CRP）,and endothelin（ET）to evaluate endothelial dysfunction.Results TC,TG,LDL-c,FT3,TSH,hsCRP,ET and Gensini score were higher in Group A than in Group B and control group（P〈0.05）.The level of NO in Group A and Group B were lower than that in control group（P〈0.05）.Multivariate Logistic regression analysis showed that age,TSH,ET and NO were independent risk factors for coronary heart disease.ET and NO levels in patients with coronary heart disease combined with subclinical hypothyroidism were correlated with Gensini scores（r=0.431,r=-0.383,P〈0.001）.Conclusion Subclinical hypothyroidism may cause endothelial dysfunction in patients with coronary heart disease,which may increase cardiovascular risk in these patients.