亚临床甲状腺功能减退与原发性高血压患者动脉粥样硬化的相关性研究

Correlation of subclinical hypothyroidism and carotid atherosclerosis in patients with essential hypertension

目的探讨亚临床甲状腺功能减退(甲减)对原发性高血压患者动脉粥样硬化的影响。方法选择2016年在上海市徐汇区中心医院住院的原发性高血压患者218例,按照甲状腺功能分为甲状腺功能正常组(157例)和亚临床甲减组(61例)。所有患者均检测血清空腹血糖、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、高敏C反应蛋白、甲状腺功能,同时测量收缩压和舒张压,彩色多普勒超声测量颈动脉内膜中层厚度。多元线性回归分析法和多元logistic回归分析法分析上述危险因素对原发性高血压患者动脉粥样硬化的影响。结果亚临床甲减组的颈动脉内膜中层厚度[(1. 2±0. 3) mm比(1. 1±0. 3) mm,P=0. 001]和颈动脉粥样斑块发生率(57. 4%比38. 9%,P=0. 015)明显高于甲状腺功能正常组。此外,多元线性回归分析结果显示随着促甲状腺激素、年龄、空腹血糖、舒张压的升高及高密度脂蛋白胆固醇的降低,颈动脉内膜中层厚度增厚;多元logistic回归分析结果显示年龄和促甲状腺激素与颈动脉粥样斑块发生率具有独立相关性。结论原发性高血压患者促甲状腺激素升高是颈动脉粥样斑块发生的独立危险因素,亚临床甲状腺功能减退可加速原发性高血压患者动脉粥样硬化的进展。

Objective To explore the relationship between subclinical hypothyroidism and carotid atherosclerosis in patients with primary hypertension. Methods A total of 218 patients with primary hypertension were enrolled into this study in Shanghai Xuhui District Central Hospital from January of 2016 to December of 2016.According to thyroid function,they were divided into euthyroidism group（157 patients）and subclinical hypothyroidism group（61 patients）.The levels of fasting plasma glucose（FPG）,total cholesterol（TC）,triglyceride（TG）,high-density lipoprotein cholesterol（HDL-C）,low-density lipoprotein in cholesterol（LDL-C）,high sensitive C reactive protein（hs-CRP）,thyroid function,systolic blood pressure（SBP）,diastolic blood pressure（DBP）and carotid artery intima-media thickness（IMT）were collected in all patients.Multiple linear regression and multiple Logistic regression was used to evaluate the impact of those risk factors above on atherosclerosis in patients with essential hypertension. Results Carotid artery intima-media thickness[IMT,（1.2±0.3）mm vs. （1.1±0.3）mm, P =0.001]and carotid artery plaque prevalence （57.4% vs. 38.9%, P =0.015）were significantly higher in subclinical hypothyroidism group than those in euthyroidism group.Multivariate regression analysis showed that increased TSH,age,fasting glucose,DBP and decreased HDL-C contribute to increased carotid IMT.Multiple Logistic regression showed age and TSH were the independent risk factor for IMT. Conclusions Increased TSH in patients with essential hypertension is an independent risk factor for carotid artery plaque prevalence.Subclinical hypothyroidism accelerates the atherosclerosis progression in patients with primary hypertension.