甲状腺功能减退患者血清同型半胱氨酸及血脂水平检测的临床意义

目的探讨甲状腺功能减退(简称甲减)患者血清同型半胱氨酸(Hcy)水平及其与并发冠心病(CHD)的关系。方法分别测定50名对照组、38例甲减治疗前组、31例甲减治疗后组空腹血清中游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、Hcy、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平,并对其进行相关分析。结果甲减患者治疗前FT3、FT4、HDL-C水平与对照组相比明显降低(P<0.01);而Hcy、TG、TC、LDL-C水平却明显高于对照组(P<0.01)。甲减患者治疗后血清FT3、FT4水平明显高于治疗前(P<0.05),而Hcy、TC、LDL-C水平较治疗前明显下降(P<0.05);TG、HDL-C水平略有下降,但与治疗前相比,差异无统计学意义(P>0.05)。相关分析表明,甲减患者Hcy与FT3、FT4水平间呈显著负相关(P<0.01),与TG水平呈显著正相关(P<0.01),而与TC、HDL-C、LDL-C均无相关性。结论血清Hcy水平升高是甲减患者并发CHD的重要危险因素。甲状腺激素水平影响了Hcy及血脂水平的代谢。测定血清Hcy水平对甲减并发CHD的诊断、治疗及预后判断具有重要临床价值。

Clinical significance of serum homocysteine and lipids determination in hypothyroidism

Objective To investigate the relationships between serum homocysteine(Hcy) in hypothyroidism with coronary heart disease(CHD). Methods The fasting serum total levels of free triiodothyronine(FT_3),free thyroxine(FT_4),Hcy,triglyceride(TG),total cholesterol(TC),high density lipoprotein-cholesterol(HDL-C) and low density lipoprotein-cholesterol(LDL-C) in 50 normal controls(group A),38 untreated patients(group B) and 31 treated and recovered patients(group C) were determined respectively.The correlation analysis were completed. Results The serum levels of FT_3,FT_4 and HDL-C in group B were significantly lower than those in group A(P<0.01).The serum levels of Hcy,TG,TC and LDL-C in group B were higher than those in group A(P<0.01).The serum levels of FT_3,FT_4 in group C were higher than those in group B(P<0.05),but the serum levels of Hcy,TC,LDL-C in group C were significantly lower than those in group B(P<0.05).The levels of serum TG,HDL-C in group C were lower slightly than those in group B,but there was no significant difference between group C and group B(P>0.05).Correlation analysis of results showed that the serum level of Hcy was negatively correlated with FT_3 and FT_4(P<0.01) and positively correlated with TG(P<0.01),but there were no linear correlation between TC,HDL-C,LDL-C and Hcy. Conclusions The higher serum level of Hcy is an important risk factor of hypothyroidism with CHD.The level of thyroid hormone effects the metabolism of serum Hcy and lipids levels.The determination of serum Hcy level has highly clinical value of the diagnosis,treatment and prognosis of hypothyroidism with CHD.