亚临床甲状腺功能异常患者促甲状腺激素与血清抵抗素、尿酸、同型半胱氨酸相关性研究

发布时间：2018-06-26 05:26

本文选题：亚临床甲状腺功能异常 + 亚临床甲亢　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:亚临床甲状腺功能异常(Subclinical thyroid dysfunction)包括亚临床甲状腺功能亢进症简称亚临床甲亢(subclinical hyperthyroidism,SH)和亚临床甲状腺功能减退症简称亚临床甲减(subclinical hypothyroidism,SCH),患者血清游离三碘甲状腺原氨酸(FT3),游离甲状腺素(FT4)水平正常而血清促甲状腺激素(TSH)水平异常,临床症状轻微,但由于其潜在的致病倾向,能引起一系列心脑血管并发症,如动脉粥样硬化、高血压等。如果不及时治疗易进展为临床甲状腺功能异常,引起机体代谢紊乱,因此近年来备受关注。亚临床甲状腺功能异常是超前性预防医学的分支,重视亚临床甲状腺功能异常,将有利于疾病的超前预防。抵抗素(Resistin)是一种新发现的脂肪细胞分泌的脂肪因子,参与了代谢疾病如动脉粥样硬化、糖尿病、胰岛素抵抗等疾病的发生发展。目前抵抗素与甲状腺功能异常关系尚无准确定论,与亚临床甲状腺功能异常还是空白。本文旨在进一步探讨亚临床甲状腺功能异常和抵抗素相互关系。高尿酸血症是指嘌呤代谢紊乱或尿酸排泄障碍引起血尿酸(Uric Acid,URIC,UA)浓度升高所致的疾病。血尿酸升高是高血压、动脉粥样硬化、蛋白尿等的独立危险因素,是心血管疾病的危险因素和胰岛素抵抗的重要表现。国内外对于亚临床甲状腺功能异常与尿酸的相关性研究尚未见报道,本文旨在研究亚临床甲状腺功能异常患者血尿酸水平变化并探讨其临床意义。同型半胱氨酸(Homocysteine,HCY)在心血管疾病的病理生理和预后中起着越来越重要的作用。其可以促进亚临床甲减,增加动脉粥样硬化的关系也越来越引起人们重视,而在亚临床甲亢中的变化研究的还不多,本文旨在探讨血浆同型半胱氨酸与甲状腺功能的相关性,为亚临床甲状腺功能异常患者提供一种客观的监测指标。亚临床甲状腺功能异常时期未采取有效措施治疗可近一步诱发血脂升高、动脉粥样硬化等并发症,因此分析与并发症相关的指标显得尤为重要。本研究拟检测亚临床甲状腺功能异常和健康体检者血清Resistin、URIC、HCY水平,发现Resistin、URIC、HCY水平在亚临床甲状腺功能异常时的作用,为预防亚临床甲状腺功能异常患者并发症的发生发展提供客观监测依据。方法:1研究对象随机选择2013年7月至2014年7月未经治疗的初诊为亚临床甲状腺疾病的患者70例,其中亚临床甲状腺功能亢进症32例作为亚临床甲亢组,其中男12例、女20例,平均年龄(34.4±13.5)岁;亚临床甲状腺功能减退症38例作为亚临床甲减组,亚临床甲减患者38例,其中男16例、女22例,平均年龄(39.1±19.6)岁;另随机选取同一时期健康体检者72例作为对照组,年龄性别与患者组相匹配。其中男30例、女42例,平均年龄(36.2±15.1)岁。分别用化学发光免疫分析法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),维生素B12(Vit B12)、叶酸(FA),用ELISA方法测定血清抵抗素(Resistin);用终点速率法测定尿酸(URIC);酶法测定同型半胱氨酸(HCY)。研究三组人群亚临床甲状腺功能异常时血清抵抗素、尿酸及血清同型半胱氨酸的水平变化。2实验方法(1)血清FT3、FT4、TSH、Vit B12、FA检测:采用化学发光免疫方法,全部实验在二级生物安全实验室进行。(2)血清URIC、HCY、及常规生化指标CHOL、TG及HDL-C、LDL-C等检测:采用全自动生化仪在二级生物安全实验室进行检测。(3)血清Resistin检测采用酶联免疫双抗体夹心法,按操作说明书在二级生物安全实验室进行检测。使用SPSS 16.0统计学软件对数据进行处理。计量资料以均数±标准差表示,3组比较采用单因素方差分析,两指标采用线性相关分析,以P0.05为差异有统计学意义。结果:1三组一般资料比较:亚临床甲亢组、亚临床甲减组及对照组三组人群在年龄、性别、BMI、FT3、FT4差异均无统计学意义(P均0.05),2亚临床甲亢组血清CHOL、LDL水平显著低于对照组(P0.05),低于亚临床甲减组(P0.05);亚临床甲减组患者血清TG、CHOL明显高于对照组,明显高于亚临床甲亢组,差异有统计学意义(P0.05),亚临床甲减组LDL与正常对照组比较没有变化但高于亚临床甲亢组(P0.05),3亚临床甲亢组与健康对照组相比Resistin升高,差异有统计学意义(P0.05),URIC、HCY比对照组明显降低,差异有统计学意义(P0.05),Vit B12、FA与对照组比较没有明显差异(P0.05)。亚临床甲减组与健康对照组相比,血清Resistin及FA下降,差异有统计学意义(P0.05);而HCY、URIC明显升高,差异有统计学意义(P均0.05)。4亚临床甲亢组、亚临床甲减组TSH与Resistin呈负相关,r值分别为-0.516(P0.01)、-0.411(P0.05),而亚临床甲亢组、亚临床甲减组TSH与HCY成正相关,r值分别为0.495、0.441,P均0.01。结论:血清Resistin、URIC和HCY的变化可能对判断亚临床甲状腺功能异常的诊断疗效及疾病的发展、治疗有辅助作用。对预防并发症的发生发展提供客观监测依据。
[Abstract]:Objective: subclinical thyroid dysfunction (Subclinical thyroid dysfunction) includes subclinical hyperthyroidism (subclinical hyperthyroidism, SH) and subclinical hypothyroidism for short, subclinical hypothyroidism (subclinical hypothyroidism, SCH), and serum free three iodine thyroidic acid (FT3). The level of free thyroxine (FT4) is normal but the level of serum thyrotropin (TSH) is abnormal and its clinical symptoms are mild. But because of its potential pathogenicity, it can cause a series of cardiovascular and cerebrovascular complications, such as atherosclerosis, hypertension, etc. if not treated in time, it may be easily progressed to abnormal thyroid function and cause metabolic disorder of the body. It has attracted much attention in recent years. Subclinical thyroid dysfunction is a branch of preemptive preventive medicine. It pays attention to subclinical hypothyroidism and will benefit the preprevention of disease. Resistin (Resistin) is a newly discovered adipocyte secreted fat factor, which is involved in metabolic diseases such as atherosclerosis, diabetes, insulin. There is no accurate relationship between resistin and thyroid function, and subclinical thyroid dysfunction or blank. This paper aims to further explore the relationship between subclinical thyroid dysfunction and resistin. Hyperuricemia refers to the blood uric acid caused by purine metabolic disorder or uric acid excretion disorder (Uri The increase of serum uric acid is an independent risk factor for hypertension, atherosclerosis and proteinuria, which is an independent risk factor for cardiovascular disease and an important manifestation of insulin resistance. The study on the correlation of subclinical thyroid dysfunction with uric acid has not been reported at home and abroad. The aim of this paper is to study the study on the relationship between C Acid and urine acid. Homocysteine (HCY) plays a more and more important role in the pathophysiology and prognosis of cardiovascular diseases. It can promote subclinical hypothyroidism and increase the relationship between atherosclerosis and atherosclerosis. The study of changes in clinical hyperthyroidism is not much. The purpose of this paper is to explore the correlation between plasma homocysteine and thyroid function, to provide an objective monitoring index for subclinical hypothyroidism patients. It is particularly important to analyze the complications associated with the complications. This study is to detect the serum levels of Resistin, URIC, and HCY in patients with subclinical thyroid dysfunction and health examination, and to find the use of Resistin, URIC, HCY levels in subclinical thyroid dysfunction, in order to prevent the complications of subclinical hypothyroidism. Objective to provide objective monitoring basis. Methods: 1 subjects randomly selected 70 cases of subclinical thyroid diseases which were initially diagnosed as subclinical thyroid disease without treatment from July 2013 to July 2014, of which 32 cases of subclinical hyperthyroidism were used as subclinical hyperthyroidism, including 12 males and 20 women, with an average age of 34.4 + 13.5 years; subclinical thyroid gland. 38 cases of hypothyroidism as subclinical hypothyroidism and 38 subclinical hypothyroidism, including 16 males and 22 females with an average age of (39.1 + 19.6) years, and 72 healthy persons at the same time as the control group, matched with the age and sex with the patient group. Among them, 30 men and 42 women, with an average age of 36.2 years (36.2 + 15.1) years, were treated with chemiluminescence. The determination of serum free three iodine thyroxine (FT3), free thyroxine (FT4) thyrotropin (TSH), vitamin B12 (Vit B12), folic acid (FA), ELISA method to determine serum resistin (Resistin), determination of serum uric acid (URIC) with end-point rate method and enzyme method for determination of homocysteine (HCY). The subclinical thyroid work of three groups of people was studied by the analysis of serum free thyrotropin (TSH). Changes in serum resistin, uric acid and serum homocysteine (1).2 test method (1) serum FT3, FT4, TSH, Vit B12, FA detection: using chemiluminescence immunoassay, all experiments were carried out in level two biosafety laboratory. (2) serum URIC, HCY, and conventional biochemical indicators CHOL, TG and HDL-C, and other tests: use full automatic biochemistry The instrument was tested in the two level biosafety laboratory. (3) the serum Resistin detection was detected by the enzyme linked immunosorbent sandwich method and was tested in the two level biosafety laboratory according to the operation instructions. The data were processed using the SPSS 16 statistical software. The measurement data were expressed in the mean number of standard deviation, and the 3 groups were compared with the single factor analysis of variance, two The index was linear correlation analysis, and P0.05 was statistically significant. Results: 1 the general data of three groups were compared: the difference of age, sex, BMI, FT3, FT4 in subclinical hyperthyroidism group, subclinical hypothyroidism group and control group was not statistically significant (P 0.05), and 2 subclinical hyperthyroidism group serum CHOL, LDL level was lower than that of control group (P0.05), lower than that of control group (P0.05). In subclinical hypothyroidism group (P0.05), the serum TG and CHOL in subclinical hypothyroidism group were significantly higher than those in the control group, obviously higher than the subclinical hyperthyroidism group, the difference was statistically significant (P0.05). The subclinical hypothyroidism group LDL and the normal control group were not changed but were higher than the subclinical hyperthyroidism group (P0.05), the 3 subclinical hyperthyroidism group was compared with the healthy control group Resistin liters. The difference was statistically significant (P0.05), URIC and HCY were significantly lower than the control group (P0.05), Vit B12, FA was not significantly different from the control group (P0.05). The serum Resistin and FA decreased in the subclinical hypothyroidism group, and the difference was statistically significant (P0.05), while HCY, the difference was statistically significant. Significance (P 0.05).4 subclinical hyperthyroidism group, subclinical hypothyroidism group TSH and Resistin negative correlation, R value is -0.516 (P0.01), -0.411 (P0.05), and subclinical hyperthyroidism group, subclinical hypothyroidism group TSH and HCY are positively correlated, R values are all likely to judge subclinical thyroid function The abnormal diagnosis and curative effect and the development of the disease have a supplementary role in the treatment. It provides objective monitoring basis for preventing the occurrence and development of complications.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R581

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