甲状腺功能减退患者血液流变学与血脂变化的观察

甲状腺功能减退患者血液流变学与血脂变化的观察朱秉武，徐君杰，戴宝珠本文对３７例原发性甲状腺功能减退（简称甲减）患者作了血液流变学和血脂检测，结果发现这些病例并存高粘滞血症与高脂血症。我们对此二者间的关系作了探讨。现报道分析如下：一、对象和方法１．对象...     

老年甲状腺功能减退患者血脂水平变化

目的探讨老年性甲状腺功能减退患者的血脂水平变化情况及其相关性。方法收集2009年2月至2014年3月在该院内分泌门诊及病房就诊的患者79例老年性甲状腺功能减退患者作为病例组,即老年性甲减组。按照对照组与病例组患者的性别构成相同,年龄相差5岁以内,随机选择同期在该科门诊或病房检查甲状腺功能正常患者79例作为对照组。两组患者空腹12 h后,于次日清晨采集静脉血10 ml,1 000 r/min,离心5 min,取其血清分装2份,一份用于检测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),另一份用于检测血清胆固醇(TC)、血清甘油三酯(TG)、血清高密度脂蛋白胆固醇(HDL-C)和血清低密度脂蛋白胆固醇(LDL-C)。比较两组患者的血脂水平有无差异,同时分析FT3、FT4、TSH与血脂的相关性。结果两组FT3、FT4、TSH水平均有统计学意义(P0.05),且老年性甲减组FT3和FT4水平均低于对照组,TSH水平高于对照组。两组TC、HDL-C、LDL-C差异均有统计学意义(P0.05),且老年性甲减组TC和LDL-C水平高于对照组,HDL-C水平低于对照组;TG无统计学意义(P0.05)。FT3与TC、TG、HDL-C、LDL-C均存在负相关性r=-0.521、-0.217、-0.181、-0.469(P0.05),其中与TC、LDL-C显著相关(P0.01)。FT4与TC、TG、HDL-C、LDL-C存在负相关性,r=-0.538、-0.202、-0.159、-0.475(P0.05),其中与TC、LDL-C显著相关(P0.01)。TSH与TC、TG、HDL-C、LDL-C均存在正相关性,r=0.551、0.293、0.167、0.471(P0.05),其中与TC、LDL-C显著相关(P0.01)。结论老年性甲状腺功能减退症可引起血脂增高,血脂与老年人甲状腺功能有较强的相关性,其中TC、LDL-C与老年人甲状腺功能显著相关。因此,血脂的检测对老年性甲状腺功能减退症的病情轻重判断、疗效观察及预后的估计具有一定的临床意义。     

香丹注射液对老年冠心病患者血脂及血液流变学的影响

目的：观察香丹注射液对老年冠心病高粘血症患者血脂、血液流变学的影响。方法：130例老年冠心病高粘血症患者分为两组，对照组44例采用常规治疗，香丹组86例在常规治疗基础上静滴香丹注射液，用药前后分别测定两组患者血液流变学及血脂指标。结果：香丹组治疗后多项指标较治疗前显著改善（P〈0.05～〈0.01），较对照组也有显著改善（P〈0．05）。结论：香丹注射液可以显著改善老年冠心病高粘血症患者的血液粘稠度及血脂水平。     

甲状腺功能减退患者治疗前后空腹血清Ghrelin水平及其相关因素

目的 观察甲状腺功能减退(甲减)患者治疗前后空腹血清Ghrelin水平的变化及相关因素分析.方法 对38例甲减患者,放射免疫分析法测定血清ghrelin水平,分析其与体重指数(BMI)、甲状腺功能、空腹血糖(FPG)、空腹胰岛素(FINS)、胰岛素抵抗指数(IR)、胰岛素敏感性指数(ISI)、游离脂肪酸(FFA)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C )、脂蛋白(a)[LP(a)]的关系,对照组34例.结果 ①甲减组治疗前空腹血清Ghrelin水平(1 098±127) ng/L,明显高于对照组(879±80) ng/L(P＜0.01);治疗后空腹血清Ghrelin水平(852±47 )ng/L,明显低于治疗前(P＜0.01),与对照组比较无统计学意义(P＞0.05).②甲减组治疗前空腹血清Ghrelin水平与ISI成正相关(r=0.499,P= 0.029).结论 甲减组治疗前表现为空腹血清Ghrelin水平升高,治疗后下降,提示ISI可能对Ghrelin水平存在影响.     

左旋甲状腺素治疗对亚临床甲状腺功能减退患者血脂和症状影响

各种原因所致亚临床甲状腺功能减退 (甲减 )患者 3 6例 ,经左旋甲状腺素治疗后 ,血清总胆固醇 ,低密度脂蛋白和甘油三酯较治疗前明显降低 (P <0 .0 5或P <0 .0 1) ,有甲减症状的部分患者症状缓解。     

甲状腺功能减退患者左心室舒张功能研究

应用多普勒超声心动图测定31例甲状腺功能减退(甲减)患者的左心室收缩功能和舒张充盈速率,并与17例对照者比较。甲减时,心率减慢、左心房增大、左心室心肌重量增高和短轴缩短率降低。左心室舒张早期充盈速率下降,舒张早期与舒张晚期充盈速率比值减低。后者与病程相关,病程3年以上者,该比值异常的发生率明显增高。10例经6个月甲状腺素治疗后,心率增快,左心房内径和左心室心肌重量减低和短轴缩短率增高,但舒张充盈速率无明显改变。研究提示,甲减患者常有左心室功能障碍,且治疗后舒张功能的恢复较收缩功能为慢。     

原发性甲状腺功能减退转变为甲状腺功能亢进五例

临床上,甲状腺功能亢进（甲亢）转变为甲状腺功能减退（甲减）较常见,例如桥本病（HT）患者早期因炎症破坏滤泡、甲状腺激素漏出而引起一过性甲状腺毒症,随着病程的延长,后期可以发生甲减。但是,在排除甲状腺激素替代治疗的影响因素之后,原发性甲减转变为甲亢则比较罕见,甲减-甲亢-甲减的转变就更为罕见。我们曾发现5例原发性甲减,在经过一段时间之后,自行转变为原发性甲亢,现将资料报告如下。     

静滴藻酸双酯钠对高脂血症血脂水平和血液流变学的影响

采用藻酸双酯钠(PSS)静脉滴注(静滴)治疗高脂血症36例的血脂水平检测结果显示:治疗后血浆总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、极低密度脂蛋白胆固醇(VLDL-C)均降低,高密度脂蛋白胆固醇(HDL-C、HDL_2-C、HDL_3-C)均升高(P<0.05～0.01);血液流变学检测结果显示:治疗后全血粘度(ηb)、血浆粘度(ηP)、还原粘度(RV)、纤维蛋白原(Fib)均降低(P <0.05～0.01).提示静滴PSS能有效地提高HDL-C、降低LDL-C和ηP,对高脂血症患者血脂水平和血液流变学方面均有有益的影响.     

老年急性脑梗塞患者血脂及血液流变学变化分析

目的研究老年急性脑梗塞患者血脂及血液流变学变化特点，并分析二者的相关性。方法７６例老年急性脑梗塞患者，测定全血粘度（ＢＶ）、血浆粘度（ＰＶ）、血小板聚集率（ＰＡｇｔ）、凝血酶时间（ＴＴ）、凝血酶原时间（ＰＴ）、白陶土部分凝血活酶时间（ＫＰＴＴ）、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）、脂蛋白（ａ）［ＬＰ（ａ）］、载脂蛋白（Ａｐｏ）Ａ１、Ｂ、Ｅ。结果ＴＣ、ＴＧ、ＨＤＬ、ＬＤＬ、ＬＰ（ａ）、ＡｐｏＡ、ＡｐｏＢ各项在急性脑梗塞组与对照组之间比较均有显著性差异，ＢＶ、ＰＶ、ＰＡｇｔ均较对照组明显升高。ＢＶ及ＰＡｇｔ分别与ＴＣ、ＴＧ、ＬＤＬ呈显著正相关，与ＨＤＬ呈显著负相关。结论血脂异常、高凝与高粘度血症构成了老年脑梗塞发病的重要环节，血脂的变化与血液流变学及凝血的改变密切相关     

甲状腺功能减退性心脏病的临床研究

目的总结甲状腺功能减退性心脏病（甲减心）临床特点。方法回顾分析39例甲减心病人临床材料。结果甲减心病人以心脏外表现为主，心脏受累表现常不典型。结论甲减心起病隐匿，进展缓慢，易于误诊，及时检查甲状腺功能等有助于明确诊断，指导治疗。     

云芝多糖对实验性高脂血症大鼠血脂和血液流变学的影响

目的 研究云芝多糖对高脂血症大鼠脂质代谢和血液流变学的影响.方法 雄性SD大鼠40只,按血脂高低将大鼠随机分为正常组,高脂组及云芝多糖高剂量(2 500 mg·kg-1·d-1)组、云芝多糖低剂量(500 mg·kg-1·d-1)组和洛伐他汀(7.2 mg·kg-1·d-1)组.正常对照组用基础饲料喂养,其余各组喂以高脂、高胆固醇饲料制备实验性高脂血症模型.给药第90天、第120天和第150天分别取血样测TC、LDL-C、TG和HDL-C.第150天取抗凝血测定血液流变学指标和取肝脏进行病理形态学检查.结果 云芝多糖呈剂量和时间依赖性明显阻遏高脂饮食所致大鼠血浆TC和LDL-C升高,提升HDL-C水平,阻遏高血脂所致的全血和血浆黏度的升高及红细胞聚集指数和红细胞比容增加,缩短高血脂所致的红细胞电泳时间延长.结论 云芝多糖长期给予具有良性调脂作用和改善高脂模型大鼠血液的黏、凝、聚状态.     

Changes in plasma concentrations of osteoprotegerin before and after levothyroxine replacement therapy in hypothyroid patients

CONTEXT: Recent study has shown that overt hypothyroidism (oHT) is associated with increased plasma osteoprotegerin (OPG) levels. OBJECTIVE: Our objective was to examine the plasma OPG level alteration before and after levothyroxine (L-T4) treatment in oHT and subclinical hypothyroidism (sHT). PATIENTS: The study subjects included oHT and sHT patients and healthy individuals (20 subjects in each group). METHODS: All patients were given L-T4 therapy to maintain a euthyroid state. Plasma OPG concentration was measured in duplicate by a sandwich ELISA. RESULTS: Plasma OPG levels in oHT and sHT before treatment were significantly higher than levels in controls (P < 0.01). After normalization of thyroid function, OPG levels in both groups decreased markedly (P < 0.01). The absolute changes in OPG showed a significant positive correlation with the changes in TSH (P < 0.05) and negative correlation with the changes in endothelium-dependent arterial dilation (P < 0.01) in hypothyroid patients during the course of treatment. CONCLUSION: OPG may be involved in the development of vascular dysfunction in hypothyroid patients.     

Alteration of plasma concentrations of OPG before and after levothyroxine replacement therapy in hypothyroid patients

OBJECTIVE: Osteoprotegerin (OPG) is a newly identified inhibitor of bone resorption. Recent studies indicate that OPG also acts as an important regulatory molecule in the vasculature. Hypothyroidism is associated with increased morbidity from cardiovascular disease. More recently, one study showed that plasma OPG increases significantly, and decreases markedly with levothyroxine (L-T4) replacement therapy in patients with overt hypothyroidism (oHT). The purpose of this study was to investigate the alteration of plasma OPG concentrations before and after L-T4 replacement therapy, and its association with endothelium-dependent arterial dilation in patients with oHT and subclinical hypothyroidism (sHT). MATERIALS AND METHODS: The study subjects included 20 women with oHT, 20 women with sHT, and 20 healthy women. All patients were then given L-T4 therapy individually to maintain all serum free T3 (FT3), free T4 (FT4), and TSH near or within the respective normal ranges. Plasma OPG concentration was measured in duplicate by a sandwich ELISA method. RESULTS: Plasma OPG levels in oHT and sHT patients before treatment were 3.13 +/- 0.27 and 2.95 +/- 0.24 ng/l, respectively, which were significantly higher than that in controls (2.42 +/- 0.26 ng/l) (p = 0.000). In multivariate analysis, OPG was significantly associated with TSH (r = 0.306, p < 0.05) and endothelium-dependent arterial dilation (r = -0.675, p < 0.01) at baseline. After normalization of thyroid function, OPG levels in both groups decreased markedly (2.53 +/- 0.28, 2.54 +/- 0.21 ng/l) (p = 0.000), and were very close to that in controls. The absolute changes in OPG showed significant positive correlation with the changes in TSH (p < 0.05) and negative correlation with the changes in endothelium-dependent arterial dilation (p < 0.01), and no significant correlation with other parameters in hypothyroid patients during the course of treatment. CONCLUSION: The plasma OPG levels were significantly increased from hypothyroid patients, and were close to those of control subjects after normalization of thyroid function, indicating that OPG acts as an important regulatory molecule in the vasculature and, particularly, that it may be involved in the development of vascular dysfunction in hypothyroid patients.     

The effects of experimental hypothyroidism on hemorheology and plasma fibrinogen concentration

Effects of hypothyroid on hemorheology of patients had widely attracted the attention of researchers during last decade. The present study has been planned with the purpose to determine the effects of experimental hypothyroidism on hemorheological parameters and fibrinogen concentration. To induce experimental hypothyroid methimazole (75 mg/100g) was added to the fodder of an experimental group rats for 20 d. After experimental duration, plasma and blood viscosity, hematocrit (Hct), hemoglobin, erythrocyte rigidity index, and plasma fibrinogen concentration values of both the control and the experimental group animals were determined and evaluated. The serum T₃ and T₄ levels of the experimental group were found lower (p<0.001) but TSH level higher (p<0.001) than that of the control group. Plasma viscosity and fibrinogen concentration of hypothyroid group were found significantly higher than controls (p<0.01). Hematocrit and hemoglobin values were also found lower in the experimental group than the control group animals (p<0.01). However, there was no significant difference found in blood viscosity at the original Hct value but there was a significant increase at standard Hct value (p<0.01). There was also no change in erythrocyte rigidity index between control and experimental groups. According to these results it may be said that in hypothyroidism, increased fibrinogen concentration may alter the rheological structure of blood by inducing increase in plasma viscosity.     

新生早期甲状腺功能减退大鼠心肌甲状腺激素受体mRNA表达的实验研究

目的探讨新生早期甲状腺功能减退（简称甲减）对大鼠心肌发育过程中甲状腺激素受体（TR）各亚型mRNA表达的影响。方法Wistar雌鼠从怀孕15d开始每天经胃灌注1％丙硫氧嘧啶2．5ml，复制甲减仔鼠动物模型，分别于各时间点称体质量后处死仔鼠，取心脏。放射免疫分析法（RIA）动态监测各组大鼠血清FT3、FT4水平，FQ—PCR方法检测各组心肌TR各亚型mRNA的表达差异。结果与对照组比较，甲减大鼠心肌TRα1 mRNA表达量在出生后0、21、45d分别下调90％、15％、36％（tod=8．33，t21d=2．58，t45d=3．25，P〈0．05），表达峰值于生后2周延迟出现。甲减大鼠心肌TRα2 mRNA表达量在出生后0、14、21、45d分别上调22％、72％、82％、36％（t0d=3．89，t14d=11．88，t21d=13．90，t45d=6．19，P〈0．05），表达峰值于生后2周延迟出现。甲减大鼠心肌TRβ1 mRNA表达量在出生后0、14、21、45d分别下调75％、62％、68％、60％（t0d=38．96，t14d=5．22，t21d=17．23，t45d=5．43，P〈0．05），表达变化趋势与对照组一致。结论新生早期甲减大鼠心肌上TR mRNA的异常表达可能与甲减性心脏病的发病机制密切相关。     

Coronary flow reserve after L-thyroxine therapy in Hashimoto's thyroiditis patients with subclinical and overt hypothyroidism

Backgound/Aims Overt and subclinical hypothyroidism are reported to be associated with increased cardiovascular disease risk. We have used coronary flow reserve (CFR) measurement by trans-thoracic Doppler echocardiography (TTDE) to determine coronary microvascular function in Hashimoto’s thyroiditis patients with overt and subclinical hypothyroidism and to evaluate effects of l-thyroxine replacement on coronary endothelial function. Methods In total, 10 overt hypothyroid patients, 10 subclinical hypothyroid patients, and 10 controls were enrolled. FT4, TSH, anti-thyroid antibodies, lipid profile, insulin, glucose, HOMA-IR, physical parameters, and CFR measured by TTDE were recorded before and after 6 months of l-thyroxine replacement in all groups. Results CFR values of all hypothyroid patients at baseline were significantly lower than those in controls. After l-thyroxine, CFR increased significantly in overt and subclinical hypothyroidism with respect to the baseline measurements (P < 0.05). When baseline and second measurements were evaluated collectively for patients and controls, CFR was positively correlated with FT4 levels (r = 0.31, P = 0.01) and negatively correlated with TSH and HOMA-IR (r = −0.38, P = 0.002 and r = −0.42, P < 0.001, respectively). Conclusion Subclinical as well as overt hypothyroid patients have impaired coronary microvascular function which improved after l-thyroxine therapy. Treatment of Hashimoto’s thyroiditis patients with subclinical hypothyroidism should be considered to improve cardiovascular disease risk.     

L-thyroxine therapy induces a fall of thyroid microsomal and thyroglobulin antibodies in idiopathic myxedema and in hypothyroid, but not in euthyroid Hashimoto's thyroiditis

Thyroid microsomal (MAb) and thyroglobulin (TgAb) antibodies were sequentially measured by sensitive and quantitative radioassays in 17 patients with goitrous Hashimoto's thyroiditis (9 hypothyroid, 8 euthyroid) and in 19 patients with idiopathic myxedema before and at various time intervals up to 24-48 months after the institution of L-thyroxine therapy. Thyroid antibodies were also determined in 5 euthyroid subjects with Hashimoto's thyroiditis maintained without treatment for a similar period. During L-thyroxine administration a reduction of MAb with respect to the pretreatment level was found in 6 of the 9 (67%) hypothyroid patients with Hashimoto's thyroiditis and in 16 of the 19 (84%) patients with idiopathic myxedema. The decrease of MAb was highly significant in both groups (p less than 0.001 and p less than 0.0001, respectively). A fall of TgAb occurred in 2 of the 3 patients (75%) with hypothyroid Hashimoto's thyroiditis and in 9 of the 10 (90%, p less than 0.001) patients with idiopathic myxedema having abnormally elevated pretreatment TgAB levels. No consistent pattern of MAb and TgAb changes was observed in the euthyroid subjects with Hashimoto's thyroiditis, whether treated or untreated. In the hypothyroid patients with Hashimoto's thyroiditis a significant association was found between the decrease of MAb and the reduction of goiter size (p less than 0.05) occurring during L-thyroxine administration. Moreover, the decrease of MAb and TgAb in idiopathic myxedema was greater (p less than 0.05) in the patients with normalized serum TSH (less than or equal to 4 microU/ml) than in those showing only a partial reduction of serum TSH (greater than 4 microU/ml) under L-thyroxine.(ABSTRACT TRUNCATED AT 250 WORDS)