亚临床甲状腺功能减退症对糖脂代谢和血管内皮功能的影响及其相关性分析

Effect of subclinical hypothyroidism on glucose and lipid metabolism and vascular endothelial function and their relationship

目的分析亚临床甲状腺功能减退症(SH)对糖脂代谢和血管内皮功能的影响及其相关性。方法选择从2015年9月—2018年1月在青海大学附属医院内分泌科接受治疗的SH患者168例作为研究对象,纳入SH组。另选同期在医院进行常规体检的健康志愿者160例作为健康对照组,对比2组甲状腺指标、血管内皮功能指标及糖脂代谢情况,并分析SH患者甲状腺指标与血管内皮功能指标及糖脂代谢指标的相关性。结果 SH组的胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)及低密度脂蛋白胆固醇(LDL-C)水平均明显高于健康对照组(t=45. 442、23. 894、54. 261,均P <0. 01)。SH组的促甲状腺激素(TSH)及内皮素-1(ET-1)水平均较对照组升高,一氧化氮(NO)水平较对照组降低,差异均有统计学意义(t=44. 652、131. 153、17. 555,P均<0. 01)。根据Spearman相关性分析发现,SH患者的TSH与NO呈负相关(r=-0. 314,P <0. 01),与ET-1、HOMA-IR、TC及LDL-C呈正相关(r=0. 425、0. 401、0. 494、0. 387,均P <0. 01)。结论SH患者的TSH与其脂质代谢指标HOMA-IR、TC、LDL-C以及血管内皮功能指标NO、ET-1关系密切,临床上可通过监测SH患者上述指标,从而明确患者的病情程度。

Objective To study the effect of subclinical hypothyroidism （SH） on glucose and lipid metabolism and vascular endothelial function,and to analyze the correlation. Methods One hundred and sixty-eight patients with SH who were treated in Department of Endocrinology of Affiliated Hospital of Qinghai University from September 2015 to January 2018 were selected as the subjects and included in the SH group. Another 160 healthy volunteers who underwent routine physical examination in our hospital in the same period were selected as control group. Thyroid indexes,vascular endothelial function and glucose and lipid metabolism were compared between the two groups. The correlation between thyroid indexes and endothelial function indexes and glycolipid metabolism indexes in patients with SH were analyzed. Results The levels of thyroid stimulating hormone （TSH） and endothelin-1 （ET-1） in SH group were higher than those in the control group,and the level of nitric oxide （NO） was lower than that of the control group （ t =44.652, t =131.153, t =17.555, all P 〈0.05）. The levels of insulin resistance index （HOMA-IR）, total cholesterol （TC） and low density lipoprotein cholesterol （LDL-C） in SH group were significantly higher than those in the control group （ t =45.442, t =23.894, t =54.261, all P 〈0.05）. According to the Spearman correlation analysis, the TSH of patients with SH was negatively correlated with NO （ r =-0.314, P 〈0.05）,and there was positively correlated with ET-1, HOMA-IR, TC and LDL-C （ r =0.425, r =0.401, r =0.494, r =0.387, all P 〈0.05）. Conclusion The TSH of patients with SH is closely related to the vascular endothelial function indexes NO,ET-1 and lipid metabolism indexes HOMA-IR, TC, LDL-C. Clinically, the above indexes of SH patients can be monitored,so as to clarify the degree of the patient＇s condition.