目的 探索亚临床甲状腺功能减退与冠心病相关性。方法 选择2013-07至2015-04在我科住院，拟诊冠心病并接受选择性冠状动脉造影患者136例，按甲状腺功能分为甲状腺功能正常组（正常组）和亚临床甲状腺功能减退组（subclinical hypothyroidism, SCH）（减退组）。再根据冠状动脉造影结果分别列入冠状动脉造影阴性组，冠状动脉1支病变、2支病变、3支病变或左主干病变组。比较各组患者的基本资料、生化指标、红细胞总数、红细胞分布宽度、冠状动脉病变数量和Gensini评分，以及超声心动图等资料。结果 减退组TC、肌酐水平高于正常组，TG水平低于正常组，差异有统计学意义（P<0.05），而血压、LDL-C、HDL-C、尿素氮、胱抑素、尿酸、FT3、FT4、红细胞总数、红细胞分布宽度等指标间差异无统计学意义。减退组冠心病患者比例与正常组相同，但冠状动脉Gensini评分（18.90±26.07）高于正常组（11.66±15.34），差异有统计学意义（P<0.05）。两组超声指标间未发现差异。结论 SCH可能影响冠状动脉病变严重程度。
Abstract
Objective To evaluate the relationship between subclinical hypothyroidism(SCH) and coronary artery disease. Methods 136 patients admitted from July 2013 to April 2015 were recruited for the study. Clinical data including age, gender, blood pressure, thyroid function, blood sugar, lipid profiles,red blood cell counts, and red cell distribution width(RDW) were analyzed. All patients received selective coronary angiography. Based on results of coronary angiography, they were categorized into one, two, three or left main artery stenosis groups and angiographic normal group. Clinical characteristics, coronary angiography, Gensini scores and echocardiographic parameters were compared. Results TC, serum creatine levels were higher and TG were lower in SCH group(P<0.05);blood pressure, LDL-C,HDL-C, urea, cystatin-C, uric acid, FT3,FT4,red blood cells,and RDW levels were not different between the groups. Number of coronary artery disease patients and number of coronary arteries involved were not different, but the Gensini scores were higher in SCH group(P<0.05). Conclusions Subclinical hypothyroidism might affect severity of coronary artery stenosis.
Key words
hypotyroidism /
subclinical /
coronary artery disease
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Hollowell J G, Staehling N W, Flanders W D, et al. Serum TSH, T(4),and thyroid antibodies in the United States population (1988 to 1994):National Health and Nutrition Examination Survey (NHANES III)[J]. J Clin Endocrinol Metab, 2002, 87(2):489-499.
[2] Surks M I, Ortiz E, Daniels G H, et al. Subclinical thyroid disease: scientific review and guidelines for diagnosis and management[J]. JAMA, 2004, 291(2):228-238.
[3] Monzani F, Caraccio N, Kozakowa M, et al. Effect of levothyroxine replacement on lipid profile and intima-media thickness in subclinical hypothyroidism: a double-blind, placebo- controlled study[J]. J Clin Endocrinol Metab, 2004, 89(5):2099-2106.
[4] Hak A E, Pols H A, Visser T J, et al. Subclinical hypothyroidism is an independent risk factor for atherosclerosis and myocardial infarction in elderly women: the Rotterdam Study[J]. Ann Intern Med, 2000, 132(4):270-278.
[5] Kvetny J, Heldgaard P E, Bladbjerg E M, et al. Subclinical hypothyroidism is associated with a low-grade inflammation, increased triglyceride levels and predicts cardiovascular disease in males below 50 years[J]. Clin Endocrinol, 2004, 61 (2):232-238.
[6] Hyland K A, Arnold A M, Lee J S, et al. Persistent Subclinical hypothyroidism and cardiovascular risk in the elderly: The Cardiovascular Health Study [J]. J Clin Endocrinol Metab, 2013,98(2): 533-540.
[7] Pearce E N, Selmer C, Olesen J B, et al. Overt and subclinical hyperthyroidism are associated with increased mortality whereas subclinical hypothyroidism is associated with decreased mortality[J]. Clin Thyroidol, 2014, 26(5):120-122.
[8] Luboshitzky R, Aviv A, Herer P, et al. Risk factors for cardiovascular disease in women with subclinical hypothyroidism[J]. Thyroid, 2002, 12(5):421-425.
[9] Liu X L, He S, Zhang S F, et al. Alteration of lipid profile in subclinical hypothyroidism: a meta-analysis[J]. Med Sci Monit, 2014, 20(20):1432-1441.
[10] Tseng F Y, Lin W Y, Lin C C, et al. Subclinical hypothyroidism is associated with increased risk for all-cause and cardiovascular mortality in adults [J]. J Am Coll Cardiol, 2012, 60(8):730-737.
[11] Biondi B, Cooper D S. The clinical significance of subclinical thyroid dysfunction[J]. Endocr Rev, 2008,29(1):76-131.
[12] Xu C, Yang X, Liu W, et al. Thyroid stimulating hormone, independent of thyroid hormone, can elevate the serum total cholesterol level in patients with coronary heart disease: a cross-sectional design[J]. Nutr Metab (Lond),2012,9(1):44.
[13] Liu D, Jiang F, Shan Z, et al. A cross-sectional survey of relationship between serum TSH level and blood pressure[J].J Hum Hyper, 2010, 24(2):134-138.
[14] Ferreira M M, Teixeira Pde F, Mansur V A. Ambulatory blood pressure monitoring in normotensive patients with subclinical hypothyroidism [J]. Arq Bras Cardiol, 2010, 94(6):806-812.
[15] Chonchol M, Lippi G, Salvagno G, et al. Prevalence of subclinical hypothyroidism in patients with chronic kidney disease[J]. Clin J Am Soc Nephrol, 2008, 3(5):1296-1300.
[16] Manjunath G, Tighiouart H, Ibrahim H, et al. Level of kidney function as a risk factor for atherosclerotic cardiovascular outcomes in the community[J]. J Am Coll Cardiol,2003,41(1):47-55.
[17] Sarnak M J, Levey A S, Schoolwerth A C, et al. Kidney disease as a risk factor for development of cardiovascular disease. A statement from the American Heart Association Councils on kidney in cardiovascular disease, high blood pressure research, clinical cardiology, and epidemiology and prevention[J]. Circulation,2003,108(17):2154-2169.
[18] Bai M F, Gao C Y, Yang C K, et al. Effects of thyroid dysfunction on the severity of coronary artery lesions and its prognosis [J]. J Cardiol,2014,64(6):496-500.
[19] Park Y J, Lee Y J, Choi S I, et al. Impact of subclinical hypothyroidism on the coronary artery disease in apparently healthy subjects[J]. Eur J Endocrinol, 2011, 165(1):115-121.
[20] Silva N, Santos O, Morais F, et al. Subclinical hypothyroidism represents an additional risk factor for coronary artery calcification, especially in subjects with intermediate and high cardiovascular risk scores[J]. Eur J Endocrinol, 2014,171(3):327-334.
[21] Tadic M, Ilic S, Kostic N, et al. Subclinical hypothyroidism and left ventricular mechanics: a three-dimensional speckle tracking study[J]. J Clin Endocrinol Metab, 2014, 99(1):307-314.
[22] Chen X, Zhang N, Cai Y, et al. Evaluation of left ventricular diastolic function using tissue Doppler echocardiography and conventional doppler echocardiography in patients with subclinical hypothyroidism aged <60 years: a meta-analysis[J]. J Cardiol, 2013,61(1):8-15.
[23] Dabbah S, Hammerman H, Markiewies W, et al. Relation between red cell distribution width and clinical outcomes after acute myocardial infarction[J]. Am J Cardiol, 2010,105(3):312-317.
[24] Lippi G, Filippozzi L, Motagnana M, et al. Clinical usefulness of measuring red blood cell distribution width on admission in patients with acute coronary syndromes[J]. Clin Chem Lab Med, 2009, 47(3):353-357.
[25] Ashizawa K, Imaizumi M, Usa T, et al. Metabolic cardiovascular disease risk factors and their clustering in subclinical hypothyroidism[J]. Clin Endocrinol (Oxf), 2010, 72(5):689-695.
[26] Nakajima Y, Yamada M, Akuzawa M, et al. Subclinical hypothyroidism and indices for metabolic syndrome in Japanese women: one-year follow-up study[J]. Endocrinol Metab, 2013,98(8):3280-3287.
PDF(707 KB)
