脑梗死合并亚临床甲状腺功能减退病人24 h尿蛋白及血同型半胱氨酸水平分析
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摘要
目的探讨脑梗死合并亚临床甲状腺功能减退(亚甲减)病人甲状腺功能与24 h尿蛋白、血同型半胱氨酸的关系。方法入选2011年1月至2017年7月海南省人民医院老年病科脑梗死病人200例。按甲状腺功能将其分为4组:对照组40例[脑梗死合并甲状腺功能正常,即游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)及促甲状腺激素(TSH)均正常]、轻度亚临床甲减组60例(FT3、FT4正常,4 m IU/L≤TSH<10 m IU/L)、重度亚甲减组60例(FT3、FT4正常,TSH≥10 m IU/L)、临床甲减组40例(FT3、FT4降低,TSH≥4 m IU/L)。其中轻度亚甲减组及重度亚甲减组的病人均分别再随机分为服药亚组和未服药亚组,各亚组均为30例。2个未服药亚组采用常规治疗,2个服药亚组加用左甲状腺素片治疗6个月。记录病人的年龄、性别、血压、血糖、血脂、甲状腺功能等,比较4组24 h尿蛋白、血同型半胱氨酸水平的差异。结果 4组病人年龄、性别、血压、血糖、血脂差异无统计学意义(P>0. 05)。脑梗死合并重度亚甲减组、临床甲减组24 h尿蛋白水平较对照组明显升高(P<0. 05)。重度亚甲减服药亚组6个月时24 h尿蛋白、同型半胱氨酸水平较重度亚甲减未服药亚组降低(P<0. 05)。结论对脑梗死病人应积极筛查甲状腺功能,及早发现和干预重度亚甲减,以减少肾损害和心脑血管疾病风险。
Objective To explore the relationship of thyroid function with 24-hour urinary protein( 24 hUP) and homocysteine( Hcy) in the patients with cerebral infarction complicated with subclinical hypothyroidism( SCHT). Methods A total of 200 patients with cerebral infarction in the Department of Geriatrics of Hainan General Hospital from January 2011 to July 2017 were enrolled. The patients were divided into four groups: control group[with normal levels of three free iodine thyroid original glycine( FT3),free thyroxine( FT4) and thyroid-stimulating hormone( TSH),40 cases],mild SCHT group( 4 m IU/LTSH<10 m IU/L,normal levels of FT3 and FT4,60 cases),severe SCHT group( TSH≥10 m IU/L,normal levels of FT3 and FT4,60 cases),and clinical hypothyroidism( CHT) group( TSH≥4 m IU/L,the levels of FT3 and FT4 decreased,40 cases).The mild SCHT group and severe SCHT group were randomly subdivided into medication group and non-medication group respectively,with 30 cases in each group.The patients in the medication group were treated with routine therapy and oral levothyrocine for 6 months,and those in the non-medication group were treated with routine therapy only. The age,gender,blood pressure,blood glucose,blood lipids,and the level of thyroid function of the patients were recorded,and the levels of24 hUP and Hcy were detected and compared among different groups. Results There were no significant differences in age,gender,blood pressure,blood glucose and blood lipids among the four groups( P>0. 05).The levels of 24 hUP and Hcy were significantly increased in severe SCHT group and CHT group than those in control group( P<0. 05).The levels of 24 hUP and Hcy in severe SCHT medication group were significantly lower than those in severe SCHT non-medication group( P< 0. 05). Conclusions It is important for the patients with cerebral infarction to detect the level of thyroid function and intervene promptly,which could help to decrease the risk of renal injury and cardio-cerebrovascular disease.
Objective To explore the relationship of thyroid function with 24-hour urinary protein( 24 hUP) and homocysteine( Hcy) in the patients with cerebral infarction complicated with subclinical hypothyroidism( SCHT). Methods A total of 200 patients with cerebral infarction in the Department of Geriatrics of Hainan General Hospital from January 2011 to July 2017 were enrolled. The patients were divided into four groups: control group[with normal levels of three free iodine thyroid original glycine( FT3),free thyroxine( FT4) and thyroid-stimulating hormone( TSH),40 cases],mild SCHT group( 4 m IU/LTSH<10 m IU/L,normal levels of FT3 and FT4,60 cases),severe SCHT group( TSH≥10 m IU/L,normal levels of FT3 and FT4,60 cases),and clinical hypothyroidism( CHT) group( TSH≥4 m IU/L,the levels of FT3 and FT4 decreased,40 cases).The mild SCHT group and severe SCHT group were randomly subdivided into medication group and non-medication group respectively,with 30 cases in each group.The patients in the medication group were treated with routine therapy and oral levothyrocine for 6 months,and those in the non-medication group were treated with routine therapy only. The age,gender,blood pressure,blood glucose,blood lipids,and the level of thyroid function of the patients were recorded,and the levels of24 hUP and Hcy were detected and compared among different groups. Results There were no significant differences in age,gender,blood pressure,blood glucose and blood lipids among the four groups( P>0. 05).The levels of 24 hUP and Hcy were significantly increased in severe SCHT group and CHT group than those in control group( P<0. 05).The levels of 24 hUP and Hcy in severe SCHT medication group were significantly lower than those in severe SCHT non-medication group( P< 0. 05). Conclusions It is important for the patients with cerebral infarction to detect the level of thyroid function and intervene promptly,which could help to decrease the risk of renal injury and cardio-cerebrovascular disease.
引文
[1]姜宏卫,刘鹏,马瑜瑾,等.亚临床甲状腺功能减退症与糖尿病肾脏疾病的相关性[J].实用医学杂志,2015,31(16):2623-2625.
[2]张冬梅,张莉,郑莹莹,等.亚临床甲状腺功能减退与2型糖尿病慢性并发症的关系[J].中国糖尿病杂志,2014,22(1):25-29.
[3]Biondi B,Cooper DS.The clinical significance of subclinical thyroid dysfunction[J].Endocr Rev,2008,29(1):76-131.
[4]Han J,Zhang TO,Xiao WH,et al.Up-regulation of visfatin expression in subjects with hyperthyroidism and hypothyroidism is partially relevant to a nonlinear regulation mechanism between visfatin and tri-iodothyronine with various concentrations[J].Chin Med J(Engl),2012,125(5):874-881.
[5]尹戴佳佳,谭旸,张严高,等.亚临床甲状腺功能减退症对心血管疾病相关影响因素的临床研究[J].重庆医学,2015,44(30):4227-4228.
[6]Ren MY,Zhang CS,Zhang XJ,et al.Acute myocardial infarction in a young man with hyperhomocysteinemia and pulmonary tuberculosis[J].Intern Med,2016,55(2):153-159.
[7]李贞铭,卢文添,朱金矿.255例2型糖尿病患者血浆同型半胱氨酸检测结果相关分析[J].齐齐哈尔医学院学报,2013,34(15):2240-2241.
[8]McDermott MT,Ridgway EC.Subclinical hypothyroidism is mild thyroid failure and should be treated[J].J Clin Endocrinol Metab,2001,86(10):4585-4590.
[9]吴波,吴海声,陈云华,等.亚临床甲减对老年慢性心力衰竭患者心功能和脑钠肽及同型半胱氨酸的影响[J].中国老年学杂志,2016,36(18):4630-4631.
[10]贾方,王小娟,田晶,等.2型糖尿病患者中亚临床甲状腺功能减退症与慢性肾脏病的相关性分析[J].山西医科大学学报,2014,45(11):1028-1031.
[11]Rodriguez-Gomez I,Banegas I,Wangensteen R,et al.Influence of thyroid state on cardiac and renal capillary density and glomerular morphology in rats[J].J Endocrinol,2013,216(1):43-51.
[12]Roodhart JM,Langenberg MH,Witteveen E,et al.The molecular basis of class side effects due to treatment with inhibitors of the VEGF/VEGFR pathway[J].Curr Clin Pharmacol,2008,3(2):132-143.
[2]张冬梅,张莉,郑莹莹,等.亚临床甲状腺功能减退与2型糖尿病慢性并发症的关系[J].中国糖尿病杂志,2014,22(1):25-29.
[3]Biondi B,Cooper DS.The clinical significance of subclinical thyroid dysfunction[J].Endocr Rev,2008,29(1):76-131.
[4]Han J,Zhang TO,Xiao WH,et al.Up-regulation of visfatin expression in subjects with hyperthyroidism and hypothyroidism is partially relevant to a nonlinear regulation mechanism between visfatin and tri-iodothyronine with various concentrations[J].Chin Med J(Engl),2012,125(5):874-881.
[5]尹戴佳佳,谭旸,张严高,等.亚临床甲状腺功能减退症对心血管疾病相关影响因素的临床研究[J].重庆医学,2015,44(30):4227-4228.
[6]Ren MY,Zhang CS,Zhang XJ,et al.Acute myocardial infarction in a young man with hyperhomocysteinemia and pulmonary tuberculosis[J].Intern Med,2016,55(2):153-159.
[7]李贞铭,卢文添,朱金矿.255例2型糖尿病患者血浆同型半胱氨酸检测结果相关分析[J].齐齐哈尔医学院学报,2013,34(15):2240-2241.
[8]McDermott MT,Ridgway EC.Subclinical hypothyroidism is mild thyroid failure and should be treated[J].J Clin Endocrinol Metab,2001,86(10):4585-4590.
[9]吴波,吴海声,陈云华,等.亚临床甲减对老年慢性心力衰竭患者心功能和脑钠肽及同型半胱氨酸的影响[J].中国老年学杂志,2016,36(18):4630-4631.
[10]贾方,王小娟,田晶,等.2型糖尿病患者中亚临床甲状腺功能减退症与慢性肾脏病的相关性分析[J].山西医科大学学报,2014,45(11):1028-1031.
[11]Rodriguez-Gomez I,Banegas I,Wangensteen R,et al.Influence of thyroid state on cardiac and renal capillary density and glomerular morphology in rats[J].J Endocrinol,2013,216(1):43-51.
[12]Roodhart JM,Langenberg MH,Witteveen E,et al.The molecular basis of class side effects due to treatment with inhibitors of the VEGF/VEGFR pathway[J].Curr Clin Pharmacol,2008,3(2):132-143.