血清TSH水平与冠心病患者脂代谢、胰岛素抵抗及左心室功能的关系研究

目的 分析血清促甲状腺素（TSH）与冠心病（CHD）患者脂代谢、胰岛素抵抗及左室功能的关系。方法 随机抽取100例CHD患者，按TSH水平分为TSH正常组（TSH为0.3~4.8 mIU/L，n=62）与TSH异常组（TSH＞4.8 mIU/L，n=38），入院时测定脂代谢总胆固醇（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）]、胰岛素抵抗指标空腹血糖（FBG）、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）]、左室功能指标左室舒张末期内径（LVEDD）、左室收缩末期左室内径（LVESD）、舒张早期二尖瓣流速峰值（E）、舒张末期流速峰值（A）、左室射血分数（LVEF）]，分析CHD患者TSH水平与上述指标的关系。结果 TSH异常组TC、TG、LDL-C、FINS、HOMA-IR、E/A、Gensini评分高于TSH正常组，LVEF低于TSH正常组（P<0.05）；TSH与CHD患者TC、TG、LDL-C、FINS、HOMA-IR、E/A、Gensini评分呈正相关，与LVEF呈负相关（P<0.05）。结论 高TSH水平可引起CHD患者脂代谢紊乱，胰岛素抵抗，造成左室功能受损，加重冠脉病变程度。

The relationship between serum TSH level and lipid metabolism, insulin resistance and left ventricular function in patients with coronary heart disease

Objective To analyze the relationship between serum thyrotropin (TSH) and lipid metabolism, insulin resistance and left ventricular function in patients with coronary heart disease (CHD). Methods 100 patients with CHD were selected randomly and they were divided into normal TSH group (TSH level between 0.3 and 4.8 mIU/L, n=62) and abnormal TSH group (TSH level > 4.8 mIU/L, n=38) according to the TSH level. Lipid metabolism total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), lipoprotein (a) Lp (a)], insulin resistance indicators fasting blood glucose (FBG), fasting insulin (FINS), insulin resistance index (HOMA-IR)] and left ventricular function indexes left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic left ventricular diameter (LVESD), peak early diastolic mitral flow velocity (E), peak end-diastolic flow velocity (A), left ventricular ejection fraction (LVEF)] were measured at admission. The relationship between TSH level and the above indicators in patietns with CHD was analyzed. Results The TC, TG, LDL-C, FINS, HOMA-IR, E/A and Gensini score in the abnormal TSH group were higher than those in the normal TSH group, while LVEF was lower than the normal TSH group (P<0.05). TSH was positively correlated with TC, TG, LDL-C, FINS, HOMA-IR, E/A, and Gensini score and negatively correlated with LVEF in patients with CHD (P<0.05). Conclusion High TSH level can cause lipid metabolism disorder and insulin resistance in patients with CHD, resulting in impaired left ventricular function and aggravation of coronary artery disease.