左甲状腺素替代治疗对甲状腺功能减退症患者血管内皮功能的影响

摘要

Objective To investigate the effect of Levothyroxine on vascular endothelial function of patients with hy-pothyroidism( DWH). Methods A total of 80 patients with hypothyroidism during January 2014 and Augest 2015 all re-ceived Levothyroxine orally. Levels of blood total triiodothyronine( TT3 ),free triiodothyronine( FT3 ),total thyroxine( TT4 ), free thyroxine( FT4 ),thyroid stimulating hormone( TSH),plasma antithrombin Ⅲ( AT-Ⅲ)activity and C-reactive protein (CRP),fibrinogen(FIB)and homocysteic acid(HCY),total cholesterol(TC),high density lipoprotein cholesterol ( HDL-C),low density lipoprotein cholesterol( LDL-C ),triglyceride( TG ) and brachial artery flow-mediated dilatation ( FMD)indexes before and after 6 months of treatment were compared. Multiple linear regression analysis was performed to analyze effects of each index on FMD function. Results After 6 months of treatment,TT3 ,FT3 ,TT4 ,FT4 ,AT-Ⅲ activity, HDL-C and FMD index levels were significantly higher,while TSH,CRP,FIB,HCY,TC,LDL-C and TG levels were signif-icantly lower than those before treatment(P﹤0. 05 or P﹤0. 01). Multiple linear regression analysis showed that TT3,TT4, FT4 ,TSH,CRP,HCY,TC and LDL-C were risk factors of FMD,while HDL-C and AT-Ⅲ activity were protection factor of FMD. Conclusion Levothyroxine treatment can improve FMD of patients with hypothyroidism.%目的：探讨甲状腺功能减退症（ hypothyroidism，PWH）患者经左甲状腺素治疗后对血管内皮功能的影响。方法选取我院2014年1月—2015年8月初治 PWH患者80例，均给予左甲状腺素口服治疗。比较治疗前、治疗后6个月血总三碘甲状腺原氨酸（ TT3）、游离三碘甲状腺原氨酸（ FT3）、总甲状腺素（ TT4）、游离甲状腺素（ FT4）、促甲状腺激素（TSH）、抗凝血酶Ⅲ（AT-Ⅲ）活性、C-反应蛋白（CRP）、纤维蛋白原（FIB）、同型半胱氨酸（HCY）、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）、甘油三酯（TG）及肱动脉血流介导的血管舒张（ flow-mediated dilatation，FMD）指数，并进一步行多元线性回归分析各实验室指标对血管内皮功能的影响。结果治疗后6个月血 TT3、FT3、TT4、FT4、AT-Ⅲ活性、HDL-C、FMD 指数明显高于治疗前，TSH、CRP、FIB、HCY、TC、LDL-C、TG明显低于治疗前，差异均有统计学意义（ P ﹤0.05或 P ﹤0.01）。多元线性回归分析结果显示：TT3、TT4、FT4、TSH、CRP、HCY、TC、LDL-C是血管内皮舒张功能的危险影响因子，HDL-C、AT-Ⅲ活性为血管内皮舒张功能的保护因子。结论通过左甲状腺素治疗能改善 PWH患者血管内皮舒张功能。