促甲状腺激素和OPN检测在甲减合并动脉粥样硬化患者中的临床意义

Study on the clinical significance of thyroid-stimulating hormone and OPN in patients with hypothyroidism complicated with atherosclerosis

目的探讨血清促甲状腺激素(TSH)和骨桥蛋白(OPN)检测在甲状腺功能减退症(简称甲减)合并动脉粥样硬化患者中的临床意义。方法选取2017年7月-2019年7月沈阳二四二医院内分泌与代谢病科门诊甲减合并动脉粥样硬化(表现为颈动脉斑块)患者365例为研究对象(观察组);同期选取本院健康体检中心的未合并动脉粥样硬化甲减患者400例作为对照组;采用全自动免疫分析仪检测TSH水平,酶联免疫吸附(ELISA)法检测OPN水平,全自动生化分析仪检测空腹血糖(FPG)、糖化血红蛋白(Hb A1c)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A1(APOA1)、载脂蛋白B(APOB)、低密度脂蛋白胆固醇(LDL-C)水平。采用Pearson法分析观察组血清TSH、OPN与血糖、血脂指标的相关性;采用多因素Logistic回归分析影响动脉粥样硬化发生的因素。结果与对照组比较,观察组血清TSH、OPN、APOB、LDL-C、颈动脉内膜厚度、斑块积分升高,HDL-C、APOA1水平降低,差异有统计学意义(P<0.05)。观察组血清TSH与OPN表达水平呈正相关(r=0.407,P<0.05),且二者与LDL-C、APOB、颈动脉内膜厚度、斑块积分呈正相关(P<0.05),与HDL-C、APOA1表达水平呈负相关(P<0.05)。优甲乐治疗6个月后观察组患者血清TSH、OPN表达水平均低于治疗前,差异有统计学意义(P<0.05)。TSH、OPN表达水平是影响动脉粥样硬化发生的独立危险因素(P<0.05),HDL-C是影响动脉粥样硬化发生的保护因素(P<0.05)。结论甲减合并动脉粥样硬化患者血清TSH、OPN高表达,血清TSH、OPN水平检测有利于延缓动脉粥样硬化的发生发展。

Objective To explore the clinical significance of serum thyroidstimulating hormone(TSH)and osteopontin(OPN)detection in patients with hypothyroidism complicated with atherosclerosis.Methods From July 2017 to July 2019,365 patients with hypothyroidism complicated with atherosclerosis(presented with carotid plaque)in the Department of Endocrinology and Metabolism of Shenyang 242 Hospital were selected as the research objects(observation group);At the same time,400 hypothyroidism patients without atherosclerosis were selected as the control group.Automatic immune analyzer was used to detect TSH level,enzyme-linked immunosorbent(ELISA)method was used to detect OPN level,automatic biochemical analyzer was used to detect fasting blood glucose(FPG),glycosylated hemoglobin(HbA1c),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),apolipoprotein A1(APOA1),apolipoprotein B(APOB),low-density lipoprotein cholesterol(LDL-C)levels.Pearson method was used to analyze the correlation between serum TSH,OPN and blood glucose,blood lipid indexes in patients with atherosclerosis;multivariate Logistic regression was used to analyze the factors affecting the occurrence of atherosclerosis.Results Compared with the control group,serum TSH,OPN,APOB and LDL-C levels,carotid intima thickness and plaque score were increased,while HDL-C and APOA1 levels were decreased in the observation group(P<0.05).In the observation group,serum TSH level was positively correlated with OPN(r=0.407,P<0.05),and positively correlated with LDL-C and APOB levels,carotid intima thickness and plaque score(P<0.05),and negatively correlated with HDL-C and APOA1 levels(P<0.05).The serum TSH and OPN levels ofpatients after 6 months of treatment of youjiale were lower than those before treatment in observation group(P<0.05).TSHand OPN levels were independent risk factors of atherosclerosis(P<0.05);HDL-C level was protective factor ofatherosclerosis(P<0.05).Conclusion Serum TSH and OPN were highly expressed in hypothyroidism complicated withatherosclerosis,and the detection of the two levels could be beneficial to delay the development of atherosclerosis.