亚临床甲减合并血脂异常患者血清甲状腺激素、Hcy水平变化及临床意义

Changes and Clinical Significance of Serum Thyroid Hormone and Hcy Levels in Patients with Subclinical Hypothyroidism and Dyslipidemia

目的:研究亚临床甲减合并血脂异常患者血清甲状腺激素、血清同型半胱氨酸(Hcy)水平变化及临床意义。方法:选择2018年6月-2019年11月在笔者所在医院内分泌科接受治疗的50例亚临床甲减患者作为研究对象,选择同期在院体检科体检的30例健康体检者作为对照组。检测所有受检者甲状腺功能三项、血Hcy与脂蛋白a[Lp(a)]水平。研究组给予口服左甲状腺素片(L-T4)25~125μg/d,8~12周后再对指标进行复查,患者甲状腺功能三项在正常值范围内后,再次复查血Hcy与Lp(a)水平。结果:研究组治疗前游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)水平均低于研究组治疗后及对照组,游离甲状腺素(TSH)、Hcy、Lp(a)水平均高于研究组治疗后及对照组,差异均有统计学意义(P<0.05)。Hcy与FT3、FT4呈负相关(r=-0.326、-0.319,P<0.05);Hcy与促甲状腺素(TSH)、Lp(a)呈正相关(r=0.436、0.417,P<0.05)。结论:亚临床甲减患者血清Hcy及Lp(a)水平会出现不同程度的增高,小剂量甲状腺素替代治疗可降低亚临床甲减患者血清Hcy及Lp(a)水平。

Objective:To study the changes and clinical significance of serum thyroid hormone and serum homocysteine(Hcy)in patients with subclinical hypothyroidism and dyslipidemia.Method:Fifty patients with subclinical hypothyroidism who received treatment in the endocrinology department of the author's hospital from June 2018 to November 2019 were selected as the research subjects,and 30 healthy subjects who received physical examination in the physical examination department of the hospital during the same period were selected as the control group.The levels of three thyroid functions,Hcy and lipoprotein a[Lp(a)]were measured in all subjects.The study group was given oral levothyroxine tablets(L-T4)25-125μg/d,and the indexes were rechecked 8-12 weeks later.After the three thyroid functions of the patients were within the normal range,the blood Hcy and Lp(a)levels were rechecked again.Result:The levels of free triiodothyronine(FT3)and free thyroxine(FT4)in the study group before treatment were lower than those in the study group after treatment and the control group,and the levels of TSH,Hcy and Lp(a)were higher than those in the study group after treatment and the control group,the differences were statistically significant(P<0.05).Hcy was negatively correlated with FT3 and FT4(r=-0.326,-0.319,P<0.05),Hcy were positively correlated with TSH and LP(a)(r=0.436,0.417,P<0.05).Conclusion:Serum Hcy and Lp(a)levels in patients with subclinical hypothyroidism increase to varying degrees,and low dose Thyroxine replacement therapy can reduce the serum Hcy and Lp(a)levels in patients with subclinical hypothyroidism.