鼻咽癌放疗后亚临床甲状腺功能减退患者血脂的变化

目的研究鼻咽癌放射治疗后亚临床甲状腺功能减退(subclinical hypothyroidism,SHT)简称亚甲减患者经左甲状腺素(LT4)治疗后甲状腺功能及血脂的变化。方法选择自1998年11月至2002年11月首程放射治疗且经病理证实的资料完整的76例鼻咽癌患者,颈部预防剂量45~60Gy,中位剂量55Gy;甲状腺受照射剂量40~60Gy,中位剂量50Gy。放射治疗后40例甲状腺功能正常为对照组,36例并发SHT为亚甲减组,给予LT4口服治疗,从25μg/d开始,逐渐加量至促甲状腺激素(TSH)恢复正常,测定治疗前后及对照组甲状腺功能包括TSH、游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)及血脂包括总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)的血清值,分别比较。结果TSH、FT3、FT4、TC、TG、HDL-C、LDL-C亚甲减组LT4治疗前与治疗后及对照组比较,除HDL-C外差异均有显著性,P<0.001或0.05;亚甲减组治疗后与对照组比较P>0.05,差异无显著性。结论鼻咽癌患者放射治疗后可导致亚甲减,经口服LT4治疗后,可改善甲状腺功能及血脂代谢异常。     

亚临床甲状腺功能减退症患者血清C反应蛋白、肿瘤坏死因子-α及动脉粥样硬化关系的研究

目的 探讨亚临床甲状腺功能减退症(亚临床甲减)患者血清C反应蛋白(CRP)、肿瘤坏死因子β (TNF-α)及动脉粥样硬化的关系.方法 75例亚临床甲减患者根据促甲状腺激素(TSH)水平分为两组:轻度亚临床甲减(TSH 5.5～10.0 mU/L)组42例,重度亚临床甲减(TSH＞ 10.0mU/L)组33例;另选取健康体检者或志愿者30例作为对照组.所有受检者均检测三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、TSH、游离甲状腺素(FT4)、游离三碘甲腺原氨酸(FT3)、CRP 以及TNF-β,并测量颈动脉内膜-中层厚度(CIMT).结果 轻度亚临床甲减组、重度亚临床甲减组、对照组CIMT分别为(0.88±0.20)、(1.12±0.21)、(0.62±0.21)mm,轻度亚临床甲减组、重度亚临床甲减组CIMT均高于对照组,重度亚临床甲减组CIMT高于轻度亚临床甲减组,差异均有统计学意义(P＜0.01).三组 CRP、TNF-α比较差异无统计学意义(P＞0.05).轻度亚临床甲减组、重度亚临床甲减组 LDL-CC[( 3.22±0.37)、(3.49±0.38)mmol/L]均高于对照组[(2.48±0.41 )mmol/L],差异有统计学意义(P＜0.01);对照组、轻度亚临床甲减组 HDL-C、TG比较差异无统计学意义(P＞0.05);与对照组、轻度亚临床甲减组比较,重度亚临床甲减组HDL-C降低[(0.92±0.10)mmol/L比(1.21±0.14)、( 1.17±0.11) mmol/L],TG 增高[(1.50±0.49) mmol/L比(1.11±0.53)、(1.27±0.47) mmol/L],差异有统计学意义(P＜0.01或＜0.05).TG、LDL-C、TSH、CRP、TNF-α与CIMT 呈正相关(r=0.52、0.37、0.48、0.39、0.45,P＜0.05或＜0.01);FT4与CIMT 呈负相关(r=-0.24,P＜0.05);HDL-C与CIMT无相关性(r=0.06,P＞0.05).结论 亚临床甲减患者存在血脂代谢紊乱等多种异常,其发生动脉粥样硬化危险性增高,但炎性反应可能不是亚临床甲减并发动脉粥样硬化的主要因素.     

亚临床甲状腺功能减退对慢性心力衰竭患者心功能的影响

目的探讨慢性心力衰竭(CHF)患者亚临床甲状腺功能减退(简称"亚临床甲减")对心功能的影响,为CHF的治疗提供新思路。方法选取2010年1月至2016年10月于武警后勤学院附属医院心内科住院的344例CHF患者为研究对象。其中,CHF合并甲状腺功能正常组233例,CHF合并亚临床甲减组111例。根据患者的血清促甲状腺素(TSH)水平,将亚临床甲减组再分为轻度亚临床甲减组(74例,TSH:4.6~9.9 mIU/L)和重度亚临床甲减组(37例,TSH≥10 mIU/L)。对两组患者进行生化指标测定和心脏彩超检测。用SPSS 17.0软件进行t检验、单因素方差分析、秩和检验和χ~2检验,用Spearman相关进行相关性分析。结果甲状腺功能正常组的白细胞、红细胞、血红蛋白水平高于轻度、重度亚临床甲减组,差异均有统计学意义(P0.05,P0.01)。Spearman相关性分析结果显示,红细胞与TSH水平呈负相关(r=-0.310,P0.01),血红蛋白含量与TSH水平呈负相关(r=-0.316,P0.01)。甲状腺功能正常组E峰流速(89 cm/s,P25~P75:76~102 cm/s)明显低于轻度、重度亚临床甲减组(分别为93 cm/s,P25~P75:83~106 cm/s和98 cm/s,P25~P75:84~114 cm/s),差异均有统计学意义(P0.01);且E峰随着TSH的升高而升高,两者呈正相关(r=0.149,P0.05)。结论 CHF患者亚临床甲减水平与贫血具有一定相关性,CHF患者亚临床甲减与心脏舒张功能降低密切相关。     

亚临床甲减合并脑梗死老年患者甲状腺功能和血脂水平变化影响评价

目的分析亚临床甲减合并脑梗死老年患者甲状腺功能及血脂水平的变化情况。方法选择2017年1月至2019年3月我院收治的脑梗死老年患者110例,予以双抗治疗后根据甲状腺功能分为持续升高组(治疗后TSH水平>4.5 m IU/L, 60例)和非持续升高组(治疗后TSH水平≤4.5 mIU/L, 50例)。对比两组的甲状腺相关激素及血脂水平,并评估TSH水平与动脉硬化指标的相关性。结果两组患者的HDL、 FT3、 FT4、 UA水平比较差异均无统计学意义(P>0.05)。持续升高组的TC、 LDL、 TG水平均明显高于非持续升高组(P <0.05)。TSH与TC、 LDL、 TG呈正相关(P <0.05), TC、 LDL是影响患者体内TSH的重要危险因素(P <0.05)。结论亚临床甲减合并脑梗死老年患者的TSH水平升高与TC、 LDL有明显相关性,持续的TSH水平上升可通过影响患者体内血脂水平而增加脑梗死的发生风险。     

孕晚期血清甲状腺激素水平与妊娠期高血压疾病患者病情严重程度的关系

目的探讨孕晚期血清甲状腺激素水平与妊娠期高血压疾病(HDCP)患者病情严重程度的关系。方法采用前瞻性设计,选取2017年1月—2019年1月杭州市余杭区第一人民医院收治的HDCP孕妇120例为HDCP组,年龄20~35岁,根据患者病情严重程度分为3个亚组,其中45例妊娠期高血压孕妇为A组、42例轻度子痫前期孕妇为B组、33例重度子痫前期孕妇为C组,另选取同期在该院检查的35例健康孕妇为对照组,年龄20~35岁。采用全自动生化分析仪测定所有孕妇孕晚期血清甲状腺激素指标[促甲状腺激素(TSH)、游离甲状腺素(FT_4)及甲状腺过氧化物酶抗体(TPOAb)]水平,采用Pearson相关性分析孕晚期血清甲状腺激素水平与HDCP患者病情严重程度的关系。筛选亚临床甲状腺功能减退者和单纯HDCP者,比较两组研究对象血脂指标的差异。结果HDCP组患者血清TSH[(4.24±1.16)mIU/L]和TPOAb[(54.16±9.96)mIU/L]水平显著高于对照组[(2.28±0.69)mIU/L、(42.05±8.93)mIU/L],差异均有统计学意义(t=12.442、6.872,均P<0.05),血清FT_4[(9.76±2.48)pmol/L]水平显著低于对照组[(14.10±3.14)pmol/L],差异有统计学意义(t=7.521,P<0.05)。HDCP组3亚组孕妇血清TSH和FT_4水平比较,差异有统计学意义(P<0.05),而3组血清TPOAb水平比较,差异无统计学意义(P>0.05),随HDCP患者病情严重程度的增加,血清TSH水平逐渐上升,血清FT_4水平逐渐下降。血清TSH水平与HDCP患者病情严重程度呈正相关关系(r=0.629,P<0.05),血清FT_4水平与HDCP患者病情严重程度呈负相关关系(r=-0.727,P<0.05),TPOAb与HDCP患者病情严重程度无相关性(r=0.235,P>0.05)。120例患者中,32例合并亚临床甲减,80例单纯HDCP,合并亚临床甲减组患者总胆固醇(TC)、三酰甘油(TG)及低密度脂蛋白胆固醇(LDL-C)水平均显著高于单纯HDCP组,差异均有统计学意义(均P<0.05),两组高密度脂蛋白胆固醇(HDL-C)水平比较,差异无统计学意义(P>0.05)。结论HDCP孕妇机体存在甲状腺激素水平改变,血清TSH水平与HDCP患者病情严重程度呈正相关关系,血清FT_4水平与HDCP患者病情严重程度呈负相关关系,且亚临床甲减可能通过影响血脂水平而引发HDCP。     

2型糖尿病患者合并甲状腺功能减退临床特点分析

目的探讨2型糖尿病(T2DM)患者合并甲状腺功能减退(简称"甲减")的临床特点。方法选取2014年1月至2016年12月在湖北省黄石市第二医院住院及门诊的1 220例T2DM患者为研究对象,依据《中国甲状腺疾病诊断指南》相关标准,设置甲减组(142例)和甲状腺功能正常组(1 047例)。收集患者的基本资料(年龄、病程等),对患者的甲状腺功能、血清总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)和糖化血红蛋白(HbA_(1C))水平进行测定。用SPSS 17.0软件进行t检验、χ~2检验和Pearson相关分析。结果 1 220例T2DM患者中甲状腺功能异常者173例,患病率为14.18%。其中,甲状腺功能减退者142例(11.64%),以亚临床甲减(9.34%)为主。与甲状腺功能正常组比较,甲减组年龄大,女性所占比例高,病程长,差异均有统计学意义(P0.01)。与甲状腺功能正常组比较,甲减组FT3、FT4和FPG水平降低,TSH、TG和LDL-C水平升高,差异均有统计学意义(P0.01)。两组患者TC、HDL-C和HbA_(1C)水平差异均无统计学意义(P0.05)。病程、TC、TG、LDL-C与TSH呈正相关(r值分别为0.273、0.139、0.288和0.132,P0.01,P0.05),FPG、HbA_(1C)与TSH呈负相关(r值分别为-0.172、-0.253,P0.01,P0.05)。而年龄、HDL-C与TSH无相关性(r值分别为0.078、0.029,P0.05)。结论 T2DM患者合并甲状腺功能减退者会出现血脂代谢紊乱,应进行早期甲状腺疾病筛查,有利于早发现、早治疗甲状腺疾病。     

冠心病患者甲状腺激素水平与血脂的相关性

目的:探讨甲状腺激素正常的冠心病患者中甲状腺激素与血脂的相关性。方法:选取我院117例冠心病患者,测定血清三碘甲状腺原氨酸(TT3)、甲状腺素(TT4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)、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)、载脂蛋白A1(apoA1)、载脂蛋白B(apoB)的水平。结果:男性组FT4与apoA1呈显著正相关(r=0.238,P<0.05);女性组TSH与apoA1呈显著负相关(r=-0.308,P<0.05)。结论:在甲状腺功能正常的冠心病患者中,甲状腺激素与血脂之间有一定的相关性。对甲状腺激素水平低的患者更应积极预防其并发心力衰竭。     

左旋甲状腺素对亚临床甲状腺功能减退症孕妇血管内皮功能及血清促甲状腺激素和脂质水平的影响

目的探讨左旋甲状腺素对亚临床甲状腺功能减退症(简称加减)孕妇血管内皮功能及血清促甲状腺激素(TSH)和脂质水平的影响。方法选取2016年7月-2017年9月在重庆市黔江中心医院产科门诊建立生产档案并确诊为亚临床甲减的76例孕妇为病例组,选择同期在同院产科门诊建立生产档案的76例健康孕妇为对照组。病例组给予左旋甲状腺素治疗。测定对照组及病例组治疗前后血清一氧化氮(NO)、内皮素-1 (ET-1)、超敏C-反应蛋白(hs-CRP)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、内皮依赖性扩张百分率(FMD%)。结果与对照组比较,病例组治疗前血清NO、FMD%水平明显降低,血清ET-1、hs-CRP水平明显升高(均P0. 05);病例组治疗后,血清NO、ET-1、hs-CRP、FMD%水平与对照组比较差异均无统计学意义(均P0. 05);与病例组治疗前相比,病例组治疗后血清NO、FMD水平明显升高,血清ET-1、hs-CRP水平明显降低(均P0. 05)。与对照组比较,病例组治疗前血清TSH水平明显升高(P0. 05);病例组治疗后血清TSH水平与对照组相近,差异无统计学意义(P0. 05);与病例组治疗前相比,病例组治疗后血清TSH水平明显降低(P0. 05);对照组、病例组治疗前、病例组治疗后血清FT3、FT4水平相近,差异均无统计学意义(均P0. 05)。与对照组比较,病例组治疗前血清TC、TG、LDL-C水平明显升高,血清HDL-C水平明显降低(均P0. 05);病例组治疗后,血清TC、TG、LDL-C、HDL-C水平与对照组相近,差异均无统计学意义(均P0. 05);与病例组治疗前相比,病例组治疗后血清TC、TG、LDL-C水平明显降低,血清HDL-C水平明显升高(均P0. 05)。结论左旋甲状腺素能明显降低亚临床甲减孕妇血清TSH水平,具有保护血管内皮功能及降低血脂的作用,应积极在临床上推广应用。     

原发性甲状腺功能减退症左旋甲状腺素治疗与血脂、同型半胱氨酸及年龄的关系

目的观察不同年龄阶段原发性甲状腺功能减退症患者左旋甲状腺素(L-T4)治疗与血脂、同型半胱氨酸(Hcy)的关系,及经单一左旋甲状腺素治疗后各指标的变化。方法将符合入选标准的原发性甲状腺功能减退症患者96例分为青年组(28例)、中年组(32例)、老年组(36例)。予单一左旋甲状腺素口服替代治疗;采集治疗前和治疗12周清晨空腹(12 h以上)静脉血进行检测。分别测定血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)和Hcy水平。结果治疗前青年组、中年组TC、LDL、Hcy水平与FT3、FT4呈显著负相关(P<0.01),TG与FT3、FT4呈负相关(P<0.05);TC、LDL、Hcy水平与TSH呈显著正相关(P<0.01),TG与TSH呈正相关(P<0.05)。治疗前老年组LDL、Hcy水平与FT3、FT4呈显著负相关(P<0.01),TC与FT3、FT4呈负相关(P<0.05);LDL、Hcy水平与TSH呈显著正相关(P<0.01),TC与TSH呈正相关(P<0.05),而TG与FT3、FT4、TSH未见相关性(P>0.05)。治疗后,青年组和中年组TC、TG、LDL、Hcy水平,及老年组TC、LDL、Hcy水平均较治疗前下降,组间比较差异有统计学意义(P<0.01);而老年组TG水平无明显变化,组间比较差异无统计学意义(P>0.05)。结论原发性甲状腺功能减退症患者血脂和Hcy水平与甲状腺功能相关;予单一L-T4治疗后,血脂、Hcy水平下降。但老年患者TG水平与甲状腺功能未见显著相关性,予L-T4治疗后,TG水平亦无明显变化。     

Graves'病放射碘治疗后甲状腺功能减退产妇乳汁和血与婴儿血甲状腺激素水平

目的 观察Graves'病服131碘(131I)后甲状腺功能减退(简称甲减)产妇乳汁和血及婴儿血甲状腺激素的水平.方法 采用直接化学发光技术的竞争免疫测定法对Graves'病131I治疗后36名出现甲减产妇(其中治愈产妇组20人,甲减产妇组16人)和正常产妇加人(正常产妇组)血、乳及婴儿的血游离三碘甲状腺原氨酸(FT3>)、游离甲状腺素(FT4)、促甲状腺素(S-TSH)指标定量检测.结果 甲减产妇组血FT3、FT4分别为(3.38±0.58)pmol/L、(7.12±1.06)pmol/L,乳汁FT3、FT4分别为(1.49±0.48)pmol/L、(3.09±0.73)pmol/L,血和乳汁S-TSH分别为(106.25±29.74)、(2.20±0.31)uIU/ml与正常产妇和治愈产妇组比较,差别均有统计学意义(P<0.01).治愈产妇组和正常产妇组乳FT3水平占血FT3的50%以上,而甲减产妇组为39%.相关分析显示,正常产妇组乳FT3与血FT3、乳FT4与血FT4呈正相关(r=分别为0.77,0.87,P<0.01).甲减产妇组乳FT4与血FT4呈正相关(r=0.99,P<0.01).甲减组婴儿TSH(6.24±0.75)uIU/ml]与正常和治愈组婴儿组比较,差别有统计学意义(P<0.01).甲减组产妇血FT4与婴儿血FT4、产妇血TSH与婴儿血TSH呈正相关(分别r=0.83、0.73,P<0.05或P<0.01).结论 甲减产妇的婴儿体内需要甲状腺激素.甲减妇女在妊娠和哺乳期不应停止甲状腺激素替代性治疗.     

Subclinical hypothyroidism and the risk of hypercholesterolemia

BACKGROUND: Subclinical hypothyroidism, defined as a mild elevation in thyroid-stimulating hormone (TSH) levels in patients with normal serum thyroxine levels, has been associated with elevationed levels in serum cholesterol in some sample populations. These studies, however, have included referred patients and large numbers of patients with previously treated hyperthyroidism. The aim of this study was to assess whether subclinical hypothyroidism is associated with abnormal lipid levels in a population-based sample. METHODS: Data from adults older than 40 years who did not previously have a diagnosis of hypothyroidism or who were taking thyroid replacement medication were analyzed from the National Health and Nutritional Examination Survey (NHANES) III. Subclinical hypothyroidism was defined as a TSH value of 6.7 to 14.9 mU/L and normal thyroxine (n = 215). Euthyroid control adults included participants with a TSH in a normal range between 0.36 and 6.7 mU/L (n = 8,013). Outcomes examined were serum cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride levels in those who had subclinical hypothyroidism and in euthyroid controls. RESULTS: Persons meeting the criteria for subclinical hypothyroidism had higher mean cholesterol levels (226 vs 217 mg/dL, P = .003) and rates of elevated cholesterol levels (74.2% vs 63.9%, P = 0.02) than the euthyroid control group, but there were no significant differences in low-density lipoprotein (LDL) or high-density lipoprotein (HDL) levels. When adjusted for age, race, sex, and the use of lipid-lowering drugs, however, subclinical hypothyroidism was not related to elevations in cholesterol levels (adjusted odds ratio [OR] = 1.06, 95% confidence interval [CI], 0.57-1.97), LDL levels (adjusted OR = 0.89; 95% CI, 0.59-1.35), or triglyceride levels (adjusted OR = 1.83; 95% CI, 0.87-3.85) or to a low HDL level (adjusted OR = 0.94; 95% CI, 0.36-2.48). CONCLUSIONS: Subclinical hypothyroidism does not appear to be associated with abnormalities in serum cholesterol or triglyceride levels when adjusted for confounding variables in this population-based study.     

Prevalence and relevance of thyroid dysfunction in 1922 cholesterol screening participants

Controversy persists about the role of subclinical hypothyroidism in hypercholesterolemia. This study aimed to assess in a clinically healthy, middle-aged population of employees the prevalence of thyroid function disorders and their relation to demographic variables and cardiovascular risk factors. 1922 (former) employees were screened with follow-up of newly identified cases of undiagnosed (subclinical) hypothyroidism and hyperthyroidism. Thyroid stimulating hormone (TSH), prevalence and course of (subclinical) hypo- and hyperthyroidism and their relation to cardiovascular risk factors (cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, smoking, systolic and diastolic blood pressure) were assessed. The prevalence of newly diagnosed subclinical hypothyroidism (cut-off TSH concentration: 4.0 mU/L) was 1.1% (17 women and 5 men) with a mean TSH concentration of 7.37 (95% CI 5.18-9.56) mU/L. No case of overt hypothyroidism could be diagnosed. Elevated levels of antibodies to microsomal or thyroglobulin antigens were detected in six subjects with subclinical hypothyroidism (27.3%). Fifteen subjects (0.8%, 13 women and 2 men) had TSH concentrations below 0.1 mU/L. The cardiovascular risk profile of subjects with mild subclinical hypothyroidism was not different from subjects with normal TSH levels. The prevalence of subclinical hypothyroidism was 0.8% in normocholesterolemic (cholesterol <5.2 mmol/l) and 1.4% in hypercholesterolemic subjects (n.s.). One woman each with the subclinical form of the disease developed hypothyroidism or hyperthyroidism after 21 and 11 months of follow-up, respectively. Subclinical hypothyroidism and subclinical hyperthyroidism were rarely observed in a target group for coronary heart disease prevention. Mild subclinical hypothyroidism was not associated with any adverse cardiovascular risk profile. These results argue against indiscriminate measurements of TSH concentrations in clinically healthy subjects either with normocholesterolemia or hypercholesterolemia.     

妊娠期甲减患者孕晚期鸢尾素水平与机体代谢指标及母婴妊娠结局的相关性分析

目的 分析妊娠期甲减患者孕晚期体内血清鸢尾素水平与机体代谢指标及母婴不良妊娠结局之间的关系。方法 研究纳入2017年5月—2018年12月共120例孕晚期甲减患者,将其分为高鸢尾素组（60例）与低鸢尾素组（60例）,同时选取100例同孕期甲状腺功能正常的孕妇作为对照。记录相关血液代谢指标和妊娠结局及胎儿或新生儿相关并发症。结果 高鸢尾素妊娠期甲减患者体重指数大于低鸢尾素组（P＜0.05）;促甲状腺激素（TSH）、甲状腺过氧化物酶抗体（TPO - Ab）高于低鸢尾素组（P＜0.05）;游离甲状腺素（FT4）低于低鸢尾素组（P＜0.05）;低密度脂蛋白胆固醇(LDL - C)、总胆固醇(TC)、三酰甘油(TG)高于低鸢尾素组（P＜0.05）;高密度脂蛋白胆固醇(HDL - C)低于低鸢尾素组（P＜0.05）。妊娠期甲减患者血清鸢尾素水平与TSH正相关（r = 0.329,P＜0.05）,而与FT4负相关（r = - 0.286,P＜0.05）。高鸢尾素妊娠期甲减患者产后出血发生率高于低鸢尾素组（P＜0.05）。同样,新生儿低体重、新生儿呼吸窘迫综合征的发生率也高于低鸢尾素组（P＜0.05）。结论 血清鸢尾素水平可反映妊娠期甲减患者病情严重程度。母婴妊娠相关并发症发生率在高鸢尾素妊娠甲减患者中较高。     

Evaluation of the relationship between subclinical hypothyroidism and metabolic syndrome components among workers

Objectives

Both hyperthyroidism and overt hypothyroidism are associated with increased prevalence of metabolic syndrome and its components, while data on subclinical hypothyroidism is currently limited especially in working populations. The aim of this study was to examine the association between subclinical hypothyroidism and metabolic syndrome components in workers; and to evaluate whether there are differences by sex and occupation.

Material and Methods

A total of 1150 university employees (male — 792, female — 358) aged 30–60 years who came for an annual medical check-up were studied. Anthropometric measurements were taken, and blood pressure, fasting plasma glucose (FPG), lipid profiles, thyroid stimulating hormone (TSH), free thyroxin (FT4) and free triiodothyronine (FT3) levels were measured.

Results

After adjustment for age and body mass index (BMI), TSH was positively associated with increased triglyceride (TG) levels (β = 0.108, p = 0.020) and FPG (β = 0.130, p = 0.006) in subclinical hypothyroid male workers. However, TSH was not associated (p > 0.05) with any component of metabolic syndrome (MS) in the euthyroid group. In females, TSH was not correlated with MS components in both euthyroid and subclinical hypothyroid groups. Furthermore, comparison by occupation showed higher TSH in subclinical hypothyroid male workers employed in administration (5.23±0.52 mU/l) than those working as academics (5.12±0.52 mU/l), which resulted in elevated systolic and diastolic blood pressure, FPG, total cholesterol, TG and high density lipoprotein cholesterol. In females, BMI, systolic and diastolic blood pressure, TG and FPG were significantly (p < 0.05) higher in subclinical hypothyroid administrators than those in academics.

Conclusions

Subclinical hypothyroidism was associated with metabolic syndrome components in male workers and not in females. Administration workers showed increased metabolic risks compared to academics. The findings suggest that the assessment of thyroid function in individuals with metabolic syndrome in the workplace may be favorable especially among men.     

亚临床甲状腺功能减退症患者血脂及超敏C反应蛋白变化分析

目的分析亚临床甲状腺功能减退症患者的血脂及超敏C反应蛋白（hs—CRP）水平变化及其临床意义。方法选取50例亚临床甲状腺功能减退症患者作为观察组,另选取与其年龄及性别相匹配的50例健康体检者作为对照组,分别测定两组的血脂及hs—CRP,并进行比较。结果观察组总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL—C）显著高于对照组[（5．20±0．84）mmol／L比（4．79±0．80）mmol／L、（2．21±0．97）mmol/L比（1．78±0．60）mmol／L、（3．25±0．65）mmol／L比（2．83±0．51）mmol／L],HDL．C显著低于对照组[（1．18±0．15）mmol／L比（1．28±0．22）mmol／L],差异均有统计学意义（P〈0．05或〈0．01）。观察组hs—CPR显著高于对照组[（4．2±1．1）mg／L比（3．0±0．8）μg／L],差异有统计学意义（P〈0．01）。结论亚临床甲状腺功能减退症可引起TC、TG、LDL-C及hs-CRP升高,HDL—C降低,由此推断其可能加速动脉硬化和心血管疾病的发生,故对本病及时筛查及干预是必要的。     

妊娠早中期亚临床甲状腺功能减退对后代甲状腺功能及智力发育的影响

目的探讨妊娠早中期亚临床甲减对后代甲状腺功能和智力发育的影响。方法选择2013年1月至2015年1月福建医科大学附属宁德市医院产科收治的妊娠早中期合并亚临床甲减的孕妇55例,其中甲状腺过氧化物酶抗体(thyroid peroxidase antibody,TPOAb)阳性组35例,TPOAb阴性组20例,单纯TPOAb阳性组30例,健康妊娠者30例为对照组。测定4组孕妇20~30月龄子代的甲状腺功能游离三碘甲状腺原氨酸(free triiodothyronine,FT_3)、游离甲状腺素(free thyroxine,FT_4)、促甲状腺激素(thyroid stimulating hormone,TSH),随访20~30月龄子代的发育商指标,比较4组婴儿有无差异。结果亚临床甲减+TPOAb(+)组、亚临床甲减+TPOAb(-)组、单纯TPOAb(+)组子代TSH水平显著高于对照组,血清FT_3、FT_4水平明显低于对照组(P0.05);亚临床甲减+TPOAb(+)组子代发育商低于其余各组,其中智力显著低于亚临床甲减+TPOAb(-)组和对照组(P0.05),而亚临床甲减+TPOAb(+)组与单纯TPOAb(+)组发育商比较差异无统计学意义(P0.05)。结论妊娠早中期亚临床甲减可能引起子代短期的甲状腺功能异常,亚临床甲减伴TPOAb(+)可能对子代神经系统发育造成影响,妊娠期单纯TPOAb(+)也可能会对子代神经智力与运动发育造成一定影响。建议对妊娠早期母体进行TPOAb的广泛筛查,如出现促甲状腺激素增高,应及时治疗。     

河北部分高水碘地区居民甲状腺功能及血脂水平调查

目的了解河北高水碘地区成人的碘营养状况、甲状腺疾病患病及血脂异常情况。方法选择河北省沧州市海兴县为调查地区,收集成人空腹晨尿及静脉血,测定其尿碘、血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺激素(FT4)、灵敏促甲状腺激素(sTSH)、血清胆固醇(CHO)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)及甲状腺球蛋白抗体(TGAb)和甲状腺过氧化物酶抗体(TPOAb)水平。结果成人尿碘中位数为1094.92μg/L(627.38～1511.81μg/L);甲状腺疾病患者有66(22.0%)人,其中甲状腺功能亢进患者3(1.0%)人,亚临床甲状腺功能亢进患者7(2.3%)人,甲状腺功能减退患者12(4.0%)人,亚临床甲状腺功能减退患者44(14.7%)人;CHO、TG、HDL-C和LDL-C水平分别为(5.46±1.06)mmol/L、2.19(1.70～2.96)mmol/L、1.18(1.03～1.45)mmol/L和(3.08±1.05)mmol/L;不同甲状腺疾病状态人群的血脂水平差异无显著性。结论该高水碘地区人群血脂异常比率偏高。     

Subclinical hypothyroidism in obese patients: relation to resting energy expenditure, serum leptin, body composition, and lipid profile

OBJECTIVE: To evaluate whether subclinical hypothyroidism (SH) affects resting energy expenditure (REE) as well as body composition, lipid profile, and serum leptin in obese patients. RESEARCH METHODS AND PROCEDURES: A total of 108 obese patients with SH defined as normal free thyroxine levels and thyroid-stimulating hormone (TSH) values of > 4.38 microU/ml (mean +/- 2 SD of the values of our reference group of obese patients with normal thyroid function) were compared with a group of 131 obese patients matched for age, sex, and body mass index (BMI) but with normal TSH levels. We assessed estimated daily caloric intake by 7-day recall, REE by indirect calorimetry, body composition by bioelectrical impedance analysis, serum leptin by radioimmunoassay, and lipid profile (i.e., total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides). RESULTS: All of the variables measured were not different between the euthyroid obese patients and those with SH. In a multiple regression model with REE expressed for kilograms of fat free mass (REE/kgFFM) as a dependent variable and percentage of fat mass, BMI, waist-to-hip ratio, age, TSH, free thyroxine, serum leptin, and caloric intake as independent variables, only percentage of fat mass was significantly correlated with REE/kgFFM in both groups. In the SH group only, BMI, waist-to-hip ratio, age, and TSH were related to REE/kgFFM and explained 69.5% of its variability. After dividing the patients with SH using a cutoff TSH value of 5.7 microU/ml, which represents 3 SD above the mean of TSH levels of the group of obese patients with normal thyroid function, only REE/kgFFM was significantly different and lower in the group of more severely hypothyroid patients. DISCUSSION: In patients with obesity, SH affects energy expenditure only when TSH is clearly above the normal range; it does not change body composition and lipid profile. We suggest that, at least in obese patients, evaluation of TSH levels may be useful to rule out a possible impairment of resting energy expenditure due to a reduced peripheral effect of thyroid hormones.     

甲状腺功能减退对妊娠期糖尿病患者糖脂代谢、心功能及妊娠结局的影响

目的探讨甲状腺功能减退对妊娠期糖尿病患者糖脂代谢、心功能及妊娠结局的影响。方法选取2016年1月-2018年8月于江山市妇幼保健院内科就诊的甲状腺功能减退合并妊娠期糖尿病患者82例作为研究组,另选取同期于本院就诊的甲状腺功能正常的妊娠期糖尿病患者80例作为对照组。比较两组孕妇甲状腺激素水平、孕妇空腹血糖(FBG)、口服75 g葡萄糖后的2 h血糖(PBG 2h)、血脂水平和脉冲多普勒超声心动图指标以及妊娠结局情况。结果研究组孕妇血清促甲状激素(TSH)水平显著高于对照组,游离甲状腺素(FT4)、游离三碘甲状原氨酸(FT3)水平显著低于对照组孕妇,差异均有统计学意义(P<0. 05)。研究组孕妇FBG、PBG 2h、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平显著高于对照组,高密度脂蛋白胆固醇(HDL-C)水平显著低于对照组孕妇,差异均有统计学意义(P<0. 05)。研究组孕妇二尖瓣口、三尖瓣口E峰显著低于对照组,A峰显著高于对照组,LVEF显著低于对照组孕妇,差异均有统计学意义(P<0. 05)。研究组孕妇前置胎盘、胎盘早剥、胎膜早破、产后出血发生率显著高于对照组孕妇,差异均有统计学意义(P<0. 05),两组剖宫产率比较差异无统计学意义(P>0. 05)。研究组胎儿生长受限、低出生体质量儿、新生儿窒息、早产发生率显著高于对照组孕妇,差异有统计学意义(P<0. 05)。结论甲状腺功能减退会加重妊娠期糖尿病患者糖脂代谢异常,进而导致孕妇血糖、血脂代谢紊乱,心脏射血功能降低,并且孕妇不良妊娠发生率显著升高。     

Asymptomatic hypothyroidism and hypercholesterolaemia.

Hypothyroidism is a cause of secondary hyperlipidaemia. This study investigates the frequency of biochemically diagnosed hypothyroidism and its relationship with plasma cholesterol concentration in apparently healthy people. Thyroid function tests (total T4, TSH, and free T4) were performed on 272 apparently healthy men and women (179 vegetarians, 93 meat eaters) with a plasma cholesterol concentration above 7 mmol/l and on 90 individuals with a plasma cholesterol below 4.1 mmol/l who were matched for age, sex and dietary habits. Six per cent of those with a plasma cholesterol above 7 mmol/l had biochemical evidence of hypothyroidism as defined by a TSH greater than 10 mIU/l (reference range 1-6) and a low free T4 below 10 pmol/l (reference range 10.1-25). Eighty per cent of these people had a high titre of thyroid anti-microsomal antibodies. Of the 90 individuals with a plasma cholesterol level below 4.1 and the 25 randomly selected participants none had biochemical evidence of hypothyroidism. Hypothyroidism is relatively common in apparently healthy people with a raised plasma cholesterol. It appears no commoner in vegetarians than in meat eaters.