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目的:观察亚临床甲减患者左旋甲状腺素(LT4)替代治疗后血脂、内皮素(ET)、一氧化氮(NO)及颈动脉内中膜厚度(CIMT)的变化,探讨亚临床甲减替代治疗对动脉粥样硬化的意义。方法:选取亚临床甲减患者45例,随机分为LT4替代组与安慰剂组,各组疗程前后分别检测低密度脂蛋白(LDL)、甘油三酯(TG)、高密度脂蛋白(HDL)、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)、一氧化氮(NO)、内皮素(ET)及CIMT。另选甲状腺功能正常者作为对照组。结果:亚临床甲减组NO较对照组减低(P<0.05),LDL、CIMT较对照组增高(P均<0.01)。LT4替代治疗后NO较治疗前增高(P<0.05),LDL、CIMT较治疗前减低(P均<0.05),并与同期安慰剂组比较差异均有统计学意义(P<0.01或P<0.05)。TG、HDL、ET各组比较差异均无统计学意义(P>0.05)。TG、LDL、CIMT与TSH呈正相关(r=0.47、r=0.39、r=0.51,P均<0.01);NO与TSH呈负相关(r=-0.23,P<0.05);HDL、ET与TSH不相关(r=0.11、r=0.07,P均>0.05);NO与CIMT呈负相关(r=-0.49,P<0.01);ET与CIMT呈正相关(r=0.62,P<0.01)。结论:LT4替代治疗可减轻亚临床甲减患者脂代谢紊乱及内皮功能失调。
Objective: To observe the changes of serum lipids, endothelin (ET), nitric oxide (NO) and carotid artery intima-media thickness (CIMT) in patients with subclinical hypothyroidism after the replacement of levothyroxine (LT4) Therapeutic significance of atherosclerosis. Methods: Forty-five patients with subclinical hypothyroidism were randomly divided into LT4 replacement group and placebo group. Before and after treatment, the levels of LDL, triglyceride (TG), high density lipoprotein (HDL) (FT3), free thyroxine (FT4), thyrotropin (TSH), nitric oxide (NO), endothelin (ET) and CIMT. Alternative normal thyroid function as a control group. Results: The NO level in subclinical hypothyroidism group was lower than that in control group (P <0.05), and the levels of LDL and CIMT were higher than those in control group (all P <0.01). Compared with the placebo group, the NO level of LT4 increased significantly (P <0.05) and LDL and CIMT decreased (P <0.05 or P <0.01 or P <0.05) ). There was no significant difference between TG, HDL and ET groups (P> 0.05). There was a positive correlation between TG, LDL, CIMT and TSH (r = 0.47, r = 0.39, r = 0.51, P <0.01) (R = 0.11, r = 0.07, P> 0.05). There was a negative correlation between NO and CIMT (r = -0.49, P <0.01). There was a positive correlation between ET and CIMT (r = 0.62, P <0.01). Conclusion: LT4 replacement therapy can reduce the lipid metabolism disorders and endothelial dysfunction in patients with subclinical hypothyroidism.