不同程度亚临床甲状腺功能减退症患者凝血和纤溶相关指标变化及其临床意义

Changes of coagulation and fibrinolysis indexes in patients with subclinical hypothyroidism and their clinical significance

目的探讨不同程度亚临床甲状腺功能减退症(SH)患者凝血及纤溶相关指标的变化及其临床意义。方法选择2019年1月至2020年6月于北京中医药大学东方医院就诊的初次诊断为SH患者85例为研究对象,根据促甲状腺激素(TSH)水平将SH患者分为轻度SH组和重度SH组;选择同期60例体检健康者作为对照组。比较3组受试者游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、TSH凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(Fib)、纤溶酶原激活物抑制物1(PAI-1)、组织型纤溶酶原激活物(t-PA)水平,分析PT、APTT及Fib、PAI-1、t-PA水平与FT3、FT4、TSH水平的相关性。结果3组受试者FT3、FT4水平比较差异无统计学意义(F=2.514、0.821,P>0.05),轻度SH组和重度SH组患者TSH水平显著高于对照组(P<0.05),重度SH组患者TSH水平显著高于轻度SH组(P<0.05)。重度SH组患者PT、APTT显著长于轻度SH组和对照组(P<0.05),Fib、PAI-1、t-PA水平显著高于轻度SH组和对照组(P<0.05);轻度SH组患者与对照组受试者PT、APTT及Fib、PAI-1、t-PA水平比较差异无统计学意义(P>0.05)。PT、APTT及Fib、PAI-1、t-PA水平与FT3、FT4、TSH水平均无相关性(P>0.05)。结论重度SH影响机体的凝血和纤溶功能,增加其他疾病尤其是心血管疾病发生的风险。

Objective To investigate the changes and clinical significance of coagulation and fibrinolysis indexes in patients with different levels of subclinical hypothyroidism(SH).Methods A total of 85 patients with SH admitted to the Dongfang Hospital,Beijing University of Chinese Medicine from January 2019 to June 2020 were selected as the study objects,the patients were divided into the mild SH group and severe SH group according to the levels of thyroid-stimulating hormone(TSH).In addition,60 healthy patients in the same period were selected as the control group.The levels of free triiodothyronine(FT3),free thyroxine(FT4),TSH,the prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(Fib),plasminogen activator inhibitor-1(PAI-1)and plasminogen activator(t-PA)of subjects in each group were compared,and the correlation between PT,APTT,Fib,PAI-1,t-PA and FT3,FT4,TSH were analyzed.Results There was no significant difference in FT3 and FT4 of subjects among the three groups(F=2.514,0.821;P>0.05),the level of TSH of subjects in the mild SH group and severe SH group was significantly higher than that in the control group(P<0.05),the level of TSH in severe SH group was significantly higher than that in the mild SH group(P<0.05).The PT,APTT of patients in the severe SH group were significantly longer than those in the mild SH group and control group(P<0.05),the levels of Fib,PAI-1 and t-PA of patients in the severe SH group were significantly higher than those in the mild SH group and control group(P<0.05),there was no significant difference in PT,APTT,Fib,PAI-1 and t-PA between the mild SH group and control group(P>0.05).There was no correlation between the PT,APTT,Fib,PAI-1,t-PA and FT3,FT4,TSH(P>0.05).Conclusion Severe SH can affect the blood coagulation and fibrinolysis of the patients,and increase the risk for occurrence of other diseases,especially cardiovascular diseases.