左旋甲状腺素钠对甲状腺功能减退症患者心肌酶谱、血脂水平及甲状腺功能的影响
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摘要
目的探讨左旋甲状腺素钠对甲状腺功能减退症患者心肌酶谱、血脂水平及甲状腺功能的影响。方法选取2015年4月至2017年4月收治的64例甲状腺功能减退症患者为研究对象,按照随机数字法分为观察组和对照组,每组32例。对照组给予甲状腺片治疗,观察组给予左旋甲状腺素钠治疗。2组连续治疗8个月,比较患者心肌酶谱[天门冬氨酸氨基转移酶(AST)、肌酸磷酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)]、血脂水平[胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]及甲状腺功能[游高三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)]等指标。结果观察组患者治疗总有效率为96. 8%明显高于对照组的78. 1%,差异有统计学意义(P <0. 05)。治疗后2组AST、CK、CK-MB、LDH指标均显著降低,观察组AST、CK、CK-MB和LDH明显低于对照组,差异有统计学意义(P <0. 05)。治疗后TC、TG、LDL水平较治疗前显著降低,差异有统计学意义(P <0. 05);观察组TC、TG、LDL水平明显低于对照组,差异有统计学意义(P <0. 05)。治疗后2组甲状腺功能较治疗前均得到显著改善,观察组FT3、FT4、TT4显著高于对照组,差异均有统计学意义(P <0. 05);观察组TSH显著低于对照组,差异有统计学意义(P <0. 05)。结论左旋甲状腺素钠有益于改善甲状腺功能减退症患者的心肌酶谱紊乱,降低血脂水平,促进甲状腺功能恢复,疗效显著,临床价值高,可在临床上推广使用。
Objective To investigate the effects of thyroxine on myocardial zymogram,blood lipid levels and thyroid function in patients with hypothyroidism. Methods A total of 64 patients with hypothyroidism who were treated in our hospital from April 2015 to April 2017 were enrolled in the study,who were divided into observation group(n = 32) and control group(n = 32) according to the random number method. The patients in control group were treated by oral thyroid tablets,however,the patients in observation group were treated by levothyroxine,with a treatment course of 8 months for both groups. The indexes including myocardial enzymes,blood lipids and thyroid function were observed and compared between the two groups.Results The total effective rate in observation group was significantly higher than that in control group(96. 8% vs 78. 1%,P < 0. 05). After treatment the myocardial enzyme levels including AST,CK,CK-MB and LDH were obviously decreased in both groups,moreover,which in observation group were significantly lower than those in control group(P < 0. 05). Afte treatment the levels of TC,TG and LDL were obviously decreased in both groups,moreover,which in observation group were significantly lower than those in control group(P < 0. 05). Moreover the thyroid function of patients in both groups was significantly improved after treatment(P < 0. 05). The levels of FT3,FT4 and TT4 in observation group were significantly higher than those in control group(P < 0. 05),however,the TSH levels in observation group were significantly lower than those in control group(P < 0. 05). Conclusion The thyroxine has the potential to effectively improve myocardial zymogram disorder in patients with hypothyroidism,which can decrease the blood lipid levels,and promote thyroid function recovery,with obvious cilinical curative effects,therefor,which can be used widely in clinical practice.
Objective To investigate the effects of thyroxine on myocardial zymogram,blood lipid levels and thyroid function in patients with hypothyroidism. Methods A total of 64 patients with hypothyroidism who were treated in our hospital from April 2015 to April 2017 were enrolled in the study,who were divided into observation group(n = 32) and control group(n = 32) according to the random number method. The patients in control group were treated by oral thyroid tablets,however,the patients in observation group were treated by levothyroxine,with a treatment course of 8 months for both groups. The indexes including myocardial enzymes,blood lipids and thyroid function were observed and compared between the two groups.Results The total effective rate in observation group was significantly higher than that in control group(96. 8% vs 78. 1%,P < 0. 05). After treatment the myocardial enzyme levels including AST,CK,CK-MB and LDH were obviously decreased in both groups,moreover,which in observation group were significantly lower than those in control group(P < 0. 05). Afte treatment the levels of TC,TG and LDL were obviously decreased in both groups,moreover,which in observation group were significantly lower than those in control group(P < 0. 05). Moreover the thyroid function of patients in both groups was significantly improved after treatment(P < 0. 05). The levels of FT3,FT4 and TT4 in observation group were significantly higher than those in control group(P < 0. 05),however,the TSH levels in observation group were significantly lower than those in control group(P < 0. 05). Conclusion The thyroxine has the potential to effectively improve myocardial zymogram disorder in patients with hypothyroidism,which can decrease the blood lipid levels,and promote thyroid function recovery,with obvious cilinical curative effects,therefor,which can be used widely in clinical practice.
引文
1曾宪忠,何晓松,王芬,等.左旋甲状腺素对甲状腺功能减退症患者脑默认网络静息态功能连接的影响.中国临床保健杂志,2017,20:14-16.
2 陈静,张政超.左甲状腺素钠对老年甲状腺功能减退症患者血清FT3、FT4及TSH水平的影响.中国急救医学,2017,13:342-348.
3 Cooper DS,Pearce EN. Subclinical hypothyroidism and hypothyroxinemia in pregnancy-still no answers. New England Journal of Medicine,2017,376:876.
4 Dutta S,Biswas KD,Ghatak S,et al. Postoperative hypofunctioning of the thyroid gland after total laryngectomy. Ear Nose Throat Journal,2016,95:443-447.
5 王婷婷,单凤玲,陆汉魁.不同化学发光免疫分析系统检测亚临床甲状腺功能减退症血清促甲状腺激素的结果对比.中华核医学与分子影像杂志,2017,37:342-345.
6 武翔宇,曹世光.左甲状腺素钠治疗甲状腺功能减退症效果观察.解放军医药杂志,2017,29:76-79.
7 Zhao JX,Endocrinology DO. Influence by thyroxine applied for senile subclinical hypothyroidism patients on their blood lipid,blood glucose and blood uric acid levels. China Practical Medicine,2016,45:234-237.
8 符宝林,符星.不同剂量左甲状腺素治疗老年亚临床甲状腺功能减退症疗效评价及对血脂的影响.药物评价研究,2017,40:1134-1137.
9 Verma VK,Yadav SK,Haldar C,et al. Daily variation in antioxidant enzymes lipid peroxidation in thyroid and plasma level thyroxine and triiodothyronine levels of a tropical bird perdiculaasiatica during reproductively active and inactive phases. Journal of Interdisciplinary Cycle Research,2016,48:387-402.
10 覃裕祺,霍仲超,吴坤.左旋甲状腺素治疗亚临床甲状腺功能减退的疗效及对血脂影响的Meta分析.广西医科大学学报,2016,33:980-985.
11 Wang XG,Chen DX,Kai LI,et al. Effects of valsartan combined with atorvastatin on cardiac function,myocardial enzymes and thyroxine levels in patients with chronic heart failure. Journal of Hainan Medical University,2017,45:234-237.
12 邢英,阿尔孜古丽·吐尔逊,郑嵘炅,等.甲状腺功能减退症患者血清心肌酶与心电图变化分析.山西医药杂志,2017,46:1720-1722.
13 王瑞玲,朱红芳,张慧,等.左甲状腺素钠片治疗妊娠期甲状腺功能减退症对甲状腺功能及妊娠结局的影响.疑难病杂志,2016,15:398-400.
14 Wang Y,Gong N,Gao C,et al. The change of left ventricular function in rats with subclinical hypothyroid and the effects of thyroxine replacement. International Journal of Endocrinology,2018,34:1-10.
15 Varner M. 70:Thyroid function in neonates of women with subclinical hypothyroidism and hypothyroxinemia. American Journal of Obstetrics&Gynecology,2017,216:S49-S50.
16 宋强.甲状腺素对老年亚临床甲状腺功能减退患者血脂、血糖、血尿酸水平的影响.医学理论与实践,2016,29:1468-1470.
17 孙敬茹,韩梅,王露,等.左甲状腺素钠联合补硒治疗甲状腺功能减退的临床疗效及对甲状腺功能的影响.疑难病杂志,2017,16:52-55.
18 Bunevicius R,Kazanavicius G,Zalinkevicius R,et al. Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. N Engl J Med,1999,340:424-429.
19 Cetinkaya E,Aslan A,Vidinlisan S,et al. Height improvement by lthyroxine treatment in subclinical hypothyroidism. Pediatrics International Official Journal of the Japan Pediatric Society,2010,45:534-537.
20 韩娥.左旋甲状腺素片对甲状腺功能减退症病人常见血液生化指标的影响.中国实用乡村医生杂志,2016,23:46-47.
2 陈静,张政超.左甲状腺素钠对老年甲状腺功能减退症患者血清FT3、FT4及TSH水平的影响.中国急救医学,2017,13:342-348.
3 Cooper DS,Pearce EN. Subclinical hypothyroidism and hypothyroxinemia in pregnancy-still no answers. New England Journal of Medicine,2017,376:876.
4 Dutta S,Biswas KD,Ghatak S,et al. Postoperative hypofunctioning of the thyroid gland after total laryngectomy. Ear Nose Throat Journal,2016,95:443-447.
5 王婷婷,单凤玲,陆汉魁.不同化学发光免疫分析系统检测亚临床甲状腺功能减退症血清促甲状腺激素的结果对比.中华核医学与分子影像杂志,2017,37:342-345.
6 武翔宇,曹世光.左甲状腺素钠治疗甲状腺功能减退症效果观察.解放军医药杂志,2017,29:76-79.
7 Zhao JX,Endocrinology DO. Influence by thyroxine applied for senile subclinical hypothyroidism patients on their blood lipid,blood glucose and blood uric acid levels. China Practical Medicine,2016,45:234-237.
8 符宝林,符星.不同剂量左甲状腺素治疗老年亚临床甲状腺功能减退症疗效评价及对血脂的影响.药物评价研究,2017,40:1134-1137.
9 Verma VK,Yadav SK,Haldar C,et al. Daily variation in antioxidant enzymes lipid peroxidation in thyroid and plasma level thyroxine and triiodothyronine levels of a tropical bird perdiculaasiatica during reproductively active and inactive phases. Journal of Interdisciplinary Cycle Research,2016,48:387-402.
10 覃裕祺,霍仲超,吴坤.左旋甲状腺素治疗亚临床甲状腺功能减退的疗效及对血脂影响的Meta分析.广西医科大学学报,2016,33:980-985.
11 Wang XG,Chen DX,Kai LI,et al. Effects of valsartan combined with atorvastatin on cardiac function,myocardial enzymes and thyroxine levels in patients with chronic heart failure. Journal of Hainan Medical University,2017,45:234-237.
12 邢英,阿尔孜古丽·吐尔逊,郑嵘炅,等.甲状腺功能减退症患者血清心肌酶与心电图变化分析.山西医药杂志,2017,46:1720-1722.
13 王瑞玲,朱红芳,张慧,等.左甲状腺素钠片治疗妊娠期甲状腺功能减退症对甲状腺功能及妊娠结局的影响.疑难病杂志,2016,15:398-400.
14 Wang Y,Gong N,Gao C,et al. The change of left ventricular function in rats with subclinical hypothyroid and the effects of thyroxine replacement. International Journal of Endocrinology,2018,34:1-10.
15 Varner M. 70:Thyroid function in neonates of women with subclinical hypothyroidism and hypothyroxinemia. American Journal of Obstetrics&Gynecology,2017,216:S49-S50.
16 宋强.甲状腺素对老年亚临床甲状腺功能减退患者血脂、血糖、血尿酸水平的影响.医学理论与实践,2016,29:1468-1470.
17 孙敬茹,韩梅,王露,等.左甲状腺素钠联合补硒治疗甲状腺功能减退的临床疗效及对甲状腺功能的影响.疑难病杂志,2017,16:52-55.
18 Bunevicius R,Kazanavicius G,Zalinkevicius R,et al. Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism. N Engl J Med,1999,340:424-429.
19 Cetinkaya E,Aslan A,Vidinlisan S,et al. Height improvement by lthyroxine treatment in subclinical hypothyroidism. Pediatrics International Official Journal of the Japan Pediatric Society,2010,45:534-537.
20 韩娥.左旋甲状腺素片对甲状腺功能减退症病人常见血液生化指标的影响.中国实用乡村医生杂志,2016,23:46-47.