开展亚临床甲状腺功能减退症的临床研究

亚临床甲状腺功能减退症 (甲减 )是一种常见的内分泌专业亚临床疾病 ,主要诊断依据是血清TSH水平增高 ,而血清FT4正常。亚临床甲减的主要不良后果是发展为临床甲减和促进缺血性心脏病的发生。影响亚临床甲减发展为临床甲减的主要因素有两个 :血清TSH水平和甲状腺自身抗体 ,两个因素有叠加作用。甲状腺激素替代治疗对于阻止亚临床甲减发展为临床甲减的效果尚不确切 ;亚临床甲减与高胆固醇血症、高血压、吸烟和糖尿病一样 ,构成动脉粥样硬化和心肌梗塞的独立危险因素 ,其对此两病的危险度分别为 1.9和 3 .1。甲状腺素纠正亚临床甲减对降低血清胆固醇有一定效果 ;妊娠妇女的亚临床甲减对后代的智力影响已经引起高度关注。我国一组根据对流行病学调查的结果 ,提出了血清TSH、甲状腺自身抗体 (TPOAb、TgAb)的正常值范围 ,以及与疾病相关的甲状腺自身抗体的切割点值 ,可供参考。

Development of clinical research on subclinical hypothyroidism

hypothyroidism is a common subclinical disease in endocrinology. Its diagnosis is based on an elevated serum TSH but normal FT 4 levels. The adverse outcome of subclinical hypothyroidism is progressing to overt hypothyroidism with an increased risk for atherosclerosis and myocardial infarction . Two factors may affect the development of overt hypothyroidism: the levels of serum TSH and thyroid autoantibodies and both factors have additional effects on the outcome. The benefits of treatment with T 4for preventing the development of overt hypothyroidism is not yet certain; subclinical hypothyroidism is a strong indicator of risk for atherosclerosis and myocardial infarction, just like other known major risk fators such as hypercholestrolemia, hypertension, smoking and diabetes (odds ratio for aortic atherosclerosis 1.9; odds ratio for myocardial infarction 3.1). The treatment with T 4 for the patients could reduce the levels of serum cholesterol. The effects of subclinical hypothyroidism in pregnant women on the IQ of their children have been widely focused. According to the results from a published epidemiological study, the normal reference values of TSH, thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb) detected by immunochemiluminesence assay (ICMA) method and the cut-off values of TPOAb and TgAb associated with thyroid diseases have been proposed.