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目的 研究左旋甲状腺素 (LT4)对老年亚临床甲状腺功能减退症 (甲减 )血脂和骨代谢的影响。 方法 78例亚临床甲减患者随机分为治疗组和对照组各 39例 ,治疗组给以LT4,平均维持量 (80 1± 37 2 ) μg/d ,对照组给以安慰剂 ,治疗前及治疗 1年后 ,观察两组临床症状、体重指数(BMI) ,血总胆固醇 (TC)、甘油三酯 (TG)、高密度脂蛋白胆固醇 (HDL C)、低密度脂蛋白胆固醇(LDL C)、载脂蛋白A1(ApoA1)、载脂蛋白B10 0 (ApoB10 0 )、钙离子 (Ca2 + )、磷离子 (P3 + )、碱性磷酸酶(AKP)的浓度及骨密度 (BMD)的变化。 结果 治疗组临床症状明显改善 ,BMI、TC、TG、LDL C、APOB10 0 显著降低〔2 4 6± 3 1vs 2 3 3± 2 2、(5 6 5± 1 4 2vs 4 4 3± 0 81)、(1 81± 0 6 6vs 1 4 3±0 4 0 )、(3 6 4± 0 84vs 2 6 8± 0 6 3)mmol/L、(0 98± 0 2 2vs 0 83± 0 2 1)g/L ,P <0 0 5或P <0 0 1〕 ,而HDL C、ApoA1、Ca2 + 、P3 + 、AKP、BMD无明显改变。 结论 LT4治疗老年人亚临床甲减可使症状缓解 ,血脂改善 ,而对骨代谢无不良影响。
Objective To investigate the effects of levothyroxine (LT4) on blood lipid and bone metabolism in elderly patients with subclinical hypothyroidism (hypothyroidism). Methods A total of 78 patients with subclinical hypothyroidism were randomly divided into treatment group (n = 39) and control group (n = 39). The treatment group was treated with LT4 and the mean maintenance dose was 80 1 ± 37 2 μg / d. The control group was given placebo, One year after the treatment, the clinical symptoms, BMI, TC, TG, HDL C, LDL C, (ApoA1), apolipoprotein B10 0 (ApoB10 0), calcium ion (Ca2 +), phosphorus ion (P3 +), alkaline phosphatase (AKP) and bone mineral density (BMD) . Results The clinical symptoms of the treatment group were significantly improved. The levels of BMI, TC, TG, LDL C and APOB10 0 were significantly lower in the treatment group (246 ± 3 1 vs 23 3 ± 2 2, (56 ± 1442 vs 443 ± 0 81) (1 81 ± 0 6 6 vs 1 43 ± 0 40), (364 ± 0 84 vs 2 68 ± 0 6 3) mmol / L, (0 98 ± 0 2 2 vs 0 83 ± 0 2 1) g / L, P <0.05 or P <0.01), while there was no significant change in HDL C, ApoA1, Ca2 +, P3 +, AKP and BMD. Conclusion The treatment of LT4 with subclinical hypothyroidism can relieve symptoms, improve blood lipids, and have no adverse effect on bone metabolism.