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目的观察不同年龄阶段原发性甲状腺功能减退症患者左旋甲状腺素(L-T4)治疗与血脂、同型半胱氨酸(Hcy)的关系,及经单一左旋甲状腺素治疗后各指标的变化。方法将符合入选标准的原发性甲状腺功能减退症患者96例分为青年组(28例)、中年组(32例)、老年组(36例)。予单一左旋甲状腺素口服替代治疗;采集治疗前和治疗12周清晨空腹(12 h以上)静脉血进行检测。分别测定血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)和Hcy水平。结果治疗前青年组、中年组TC、LDL、Hcy水平与FT3、FT4呈显著负相关(P<0.01),TG与FT3、FT4呈负相关(P<0.05);TC、LDL、Hcy水平与TSH呈显著正相关(P<0.01),TG与TSH呈正相关(P<0.05)。治疗前老年组LDL、Hcy水平与FT3、FT4呈显著负相关(P<0.01),TC与FT3、FT4呈负相关(P<0.05);LDL、Hcy水平与TSH呈显著正相关(P<0.01),TC与TSH呈正相关(P<0.05),而TG与FT3、FT4、TSH未见相关性(P>0.05)。治疗后,青年组和中年组TC、TG、LDL、Hcy水平,及老年组TC、LDL、Hcy水平均较治疗前下降,组间比较差异有统计学意义(P<0.01);而老年组TG水平无明显变化,组间比较差异无统计学意义(P>0.05)。结论原发性甲状腺功能减退症患者血脂和Hcy水平与甲状腺功能相关;予单一L-T4治疗后,血脂、Hcy水平下降。但老年患者TG水平与甲状腺功能未见显著相关性,予L-T4治疗后,TG水平亦无明显变化。
Objective To observe the relationship between L-T4 treatment and plasma lipids and homocysteine (Hcy) in patients with primary hypothyroidism at different ages and the changes of each index after single levothyroxine treatment. Methods Ninety-six patients with primary hypothyroidism who met the inclusion criteria were divided into young group (28 cases), middle-aged group (32 cases) and elderly group (36 cases). To a single L-thyroxine oral replacement therapy; collection before treatment and treatment of 12 weeks early morning fasting (more than 12 h) venous blood testing. Serum free triiodothyronine (FT3), free thyroxine (FT4), thyrotropin (TSH), total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) Level. Results Before treatment, the levels of TC, LDL and Hcy in the young and middle-aged groups were negatively correlated with FT3 and FT4 (P <0.01), but negatively correlated with FT3 and FT4 (P <0.05) TSH (P <0.01), TG and TSH were positively correlated (P <0.05). The levels of LDL and Hcy in the elderly group before treatment were negatively correlated with FT3 and FT4 (P <0.01), but negatively correlated with FT3 and FT4 (P <0.05). The levels of LDL and Hcy were positively correlated with TSH ). There was a positive correlation between TC and TSH (P <0.05), while there was no correlation between TG and FT3, FT4 and TSH (P> 0.05). After treatment, the levels of TC, TG, LDL and Hcy in youth group and middle-aged group and the levels of TC, LDL and Hcy in elderly group decreased compared with those before treatment, with significant difference between the two groups (P <0.01) There was no significant difference in TG level between the two groups (P> 0.05). Conclusions The levels of serum lipids and Hcy in patients with primary hypothyroidism are associated with thyroid function. After single L-T4 treatment, the levels of lipids and Hcy decrease. However, TG levels in elderly patients and thyroid function was not significantly correlated, to L-T4 treatment, TG levels did not change significantly.