甲状腺功能减退、亢进患者血浆总同型半胱氨酸水平的临床研究

Clinical study of the plasma homocysteine level in hyperthyroid and hypothyroid patients before and after treatment

目的 :了解甲减和甲亢患者血浆总同型半脱氨酸水平及临床意义。方法 :甲减患者24例和甲亢患者38例 ,取其治疗前、后血浆 ,用高效液相色谱法测定总同型半胱氨酸水平 ,用放射免疫法测定叶酸和维生素B12,酶法测定胆固醇。结果 :治疗前甲减组总同型半胱氨酸与胆固醇水平较甲亢组显著升高 ,叶酸较甲亢组显著降低 ,维生素B12 水平差异无显著性。甲减组治疗后的总同型光胱氨酸、胆固醇水平较治疗前显著下降 ,而甲亢组治疗后的总同型半胱氨酸、胆固醇水平较治疗前显著上升。治疗后甲减和甲亢组总同型半胱氨酸、胆固醇、叶酸、维生素B12 及FT4 水平差异均无显著性。四组间维生素B12 水平差异均无显著性。同一患者治疗前后血浆总同型半胱氨酸的差值和治疗后前FT4 的比值作多重线性回归分析提示有负相关性 ,相关系数R=0.354,t=5.26,P<0 01。结论 :血浆总同型半胱氨酸水平可能对判断甲状腺功能有辅助作用 。

Objective:To study the clinical significance and the possible relationship between plasma homocysteine in hyperthyroid and hyˉpothyroid patients before and after treatment.Methods:Plasma homocysteine levels of24cases with hypothyroid and38subjects with hyperthyroid were measured by using high performance liquid chromatography(HPLC)with fluorescence detection,serum folic acid and vitamin B12levels were measured with radioassay method,and serum cholesterol levels were measured with enzyme assay method.These measurements were taken again when those patients'thyroid functions were recovered thought treatment.Results:Plasma homocysteine and cholesterol in hypothyroid patients were much higher than those in hyperthyroid ones before treatment,the serum folic acid in hypothyroid patients was much lower than those in the hyˉperthyroid ones before treatment,there was no significant difference in vitamin B12level between them.Plasma homocysteine and cholesterol in hypothyroid patients after treatment were much lower than those before treatment,while homocysteine and cholesterol in hyperthyroid patients after treatment was much higher than those before treatment.The levels of these markers in the two groups patients after treatment had no obvious difˉference.The data of serum vitamin B12in all patients had no statistical difference.The levels of plasma homocysteine had negative correlation to serum free T4.Conclusion:The level of plasma homocysteine may be an assistant factor to determine thyroid function.High homocysteinemia in hypothyroid is a possible risk pactor of vascular occlusive disease.