亚临床甲状腺功能减退患者促甲状腺素与颈部动脉内膜中层厚度和抵抗素相关性分析

Relationships between TSH and carotid artery intima media thickness and resistin in SCH patients with subclinical hypothyroidism

目的近年来,亚临床甲状腺功能减退(subclinicalhypothyroidism,SCH)检出率明显增加,而SCH可增加心、脑血管疾病的发生风险。本研究旨在探讨健康查体中SCH患者促甲状腺素(thyroid-stimulatinghormone,TSH)与颈动脉内膜中层厚度(intima-median thickness,IMT)和抵抗素(resistin,RE)的关系。方法选择2016-05-09-2017-08-30泰安市第四人民医院健康查体的铁路职工中初诊未经治疗的SCH患者68例作为研究对象,其中4.7mU/L <TSH<10mU/L)36例为A组,TSH≥10mU/L 32例为B组,另选健康者40名为对照组。分别测定三组体质量指数(body mass index,BMI)、TSH、游离三碘甲状腺原氨酸(free T3,FT3)、游离甲状腺激素(free T4,FT4)、空腹血糖(fasting blood glucose,FBG)、三酰甘油(triglycerid,TG)、总胆固醇(cholesterol,TC)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、IMT和RE。结果 TSH水平A组为(7.46±1.49)mU/L,B组为(12.11±1.03)mU/L,均高于对照组的(2.53±0.81)mU/L,F=41.26,P<0.001。TG水平A组为(2.31±1.02)mmol/L,B组为(2.92±0.91)mmol/L,均高于对照组的(1.60±0.41)mmol/L,F=3.87,P=0.025。TC水平A组为(5.02±0.49)mmol/L,B组为(5.56±0.63)mmol/L,均高于对照组的(4.51±0.52)mmol/L,F=3.90,P=0.023。LDL-C水平A组为(3.16±0.43)mmol/L,B组为(3.81±0.49)mmol/L,均高于对照组的(2.45±0.55)mmol/L,F=3.95,P=0.021。A组IMT为(1.02±0.16)mm,B组为(1.23±0.15)mm,均高于对照组的(0.75±0.09)mm,F=46.71,P<0.001。A组RE为(59.13±6.42)μg/L,B组为(52.69±5.33)μg/L,均低于对照组的(66.05±7.35)μg/L,F=52.61,P<0.001。TSH分别与TC(r=0.293,P<0.05)、TG(r=0.326,P<0.05)、LDL-C(r=0.352,P<0.05)和IMT(r=0.337,P<0.05)呈正相关,而TSH与RE呈负相关(r=-0.766 5,P<0.05)。利用多元逐步回归分析,进入IMT为因变量的回归方程的为TSH(β=0.265,t=2.161,P=0.036),TC(β=0.316,t=5.459,P=0.019);进入RE为因变量的回归方程的为TSH(β=-0.322,t=-2.568,P=0.012)、TC(β=-0.296,t=-2.382,P=0.027)和LDL-C(β=-0.410,t=-3.217,P=0.004)。结论 TSH分别与TC、TG、LDL-C、IMT呈正相关,与RE呈负相关。TSH水平可影响颈动脉IMT、RE和血脂代谢,从而使SCH可通过影响患者脂代谢、免疫炎症反应及血管动脉硬化,增加患者心、脑血管疾病的发生风险。

OBJECTIVE In recent years,the detection rate of subclinical hypothyroidism（SCH）has increased significantly.SCH can increase the risk of cardiovascular and cerebrovascular diseases.The purpose of this study is to investigate the relationship between thyroid-stimulatinghormone（TSH）and carotid intima-media thickness（IMT）and resistin（RE）in SCH patients.METHODS A total of 68 cases of newly diagnosed untreated SCH among railway workers in Taian Fourth People＇s Hospital from May 9,2016 to August 30,2017 were selected as research subjects.Among them,there were 36 patients in group A（4.7 mU/L〈TSH〈10 mU/L）and 32 patients in group B（TSH≥10 mU/L）,at the same time,40 healthy persons were selected as the control group.Body mass index（BMI）,TSH,free three iodine thyroxine（FT3）,free thyroid hormone（FT4）,fasting blood glucose（FBG）,triglycerides（TG）,total cholesterol（TC）,High density lipoprotein cholesterol（HDL-C）,low density lipoprotein cholesterol（LDL-C）,IMT and RE of three group were measured.RESULTS The levels of TSH in group A and group B were（7.46±1.49）mU/L and（12.11±1.03）mU/L,respectively,significantly higher than that in the control group（2.53±0.81）mU/L,F=41.26,P〈0.001.The levels of TG in group A and group B were（2.31±1.02）mmol/L and（2.92±0.91）mmol/L,respectively,significantly higher than that in the control group（1.60±0.41）mmol/L,F=3.87,P=0.025.The levels of TC in group A and group B were（5.02±0.49）mmol/L,（5.56±0.63）mmol/L,respectively,significantly higher than that in the control group（4.51±0.52）mmol/L.F=3.90,P=0.023.The levels of LDL-C in group A and group B was（3.16±0.43）mmol/L,（3.81±0.49）mmol/L,respectively,significantly higher than that in the control group（2.45±0.55）mmol/L,F=3.95,P=0.021.The levels of IMT in group A and group B was（1.02±0.16）mm,（1.23±0.15）mm,respectively,significantly higher than that in the control group（0.75±0.09）mm,F=46.71,P〈0.001.The levels of RE in group A and group B was（59.13±6.42）μg/L,（52.69±5.33）μg/L,respectively,significantly lower than that in the control group（66.05±7.35）μg/L,F=52.61,P〈0.001.TSH is positively correlated with TC（r=0.293,P〈0.05）,TG（r=0.326,P〈0.05）,LDL-C（r=0.352,P〈0.05）,IMT（r=0.337,P〈0.05）.However,TSH was negatively correlated with resistin（r=-0.7665,P〈0.05）.Using multivariate stepwise regression analysis,the regression equations that entered IMT as the dependent variable were TSH（β=0.265,t=2.161,P=0.036）,TC（β=0.316,t=5.459,P=0.019）.The regression equation that entered RE as the dependent variable were TSH（β=-0.322,t=-2.568,P=0.012）,TC（β=-0.296,t=-2.382,P=0.027）,LDL-C（β=-0.410,t=-3.217,P=0.004）.CONCLUSIONS TSH is positively correlated with TC,TG,LDL-C and IMT,and negatively correlated with RE.The level of TSH can affect the metabolism of IMT,RE and blood lipids in the carotid artery,so that SCH can increase the risk of cardiac and cerebrovascular diseases by affecting the patients＇ lipid metabolism,immune inflammatory response and arteriosclerosis.