Dessein Patrick H, Joffe Barry I, Stanwix Anne E
Department of Rheumatology, Johannesburg Hospital and Milpark Hospital, University of the Witwatersrand, Johannesburg, South Africa.
Thyroid. 2004 Jun;14(6):443-6. doi: 10.1089/105072504323150750.
We investigated the prevalence of subclinical hypothyroidism and its association with insulin resistance and other cardiovascular (CV) risk factors in rheumatoid arthritis (RA). We recorded thyroid function tests, insulin resistance markers comprising the Homeostasis Model Assessment for insulin resistance (HOMA-IR), the Quantitative Insulin Sensitivity Check Index (QUICKI) and triglycerides/high-density lipoprotein (HDL) cholesterol ratios, and other CV risk factors in 126 patients with RA. Fifteen (12%) were taking thyroxine for hypothyroidism and 14 (11%) had subclinical hypothyroidism (thyrotropin > 4 mU/L and normal free thyroxine levels). Compared to the 97 euthyroid patients, the QUICKI was lower and the HOMA-IR higher in treated (p = 0.031 for both) and subclinical (p = 0.004 for both) hypothyroid cases while the triglycerides/HDL cholesterol ratios were higher in subclinical (p = 0.039) but not in treated hypothyroid (p = 0.365) cases. Treated hypothyroid patients were more often hypertensive (n = 11 [75%]) than euthyroid patients (n = 36 [37%]) (p = 0.008). No other differences in characteristics were found among the three groups. After controlling for potentially confounding variables, subclinical hypothyroidism remained independently predictive of the HOMA-IR and QUICKI (p <or= 0.06) while treated hypothyroidism did not (p = 0.2). Subclinical hypothyroidism was commonly encountered and associated with insulin resistance and its related dyslipidemia in RA. Evaluation of thyroid function should be considered in future studies aimed at delineating CV risk in RA.
我们调查了类风湿关节炎（RA）患者中亚临床甲状腺功能减退的患病率及其与胰岛素抵抗和其他心血管（CV）危险因素的关联。我们记录了126例RA患者的甲状腺功能测试、胰岛素抵抗标志物，包括胰岛素抵抗稳态模型评估（HOMA-IR）、定量胰岛素敏感性检查指数（QUICKI）以及甘油三酯/高密度脂蛋白（HDL）胆固醇比值，还有其他CV危险因素。15例（12%）因甲状腺功能减退正在服用甲状腺素，14例（11%）患有亚临床甲状腺功能减退（促甲状腺激素>4 mU/L且游离甲状腺素水平正常）。与97例甲状腺功能正常的患者相比，接受治疗的（两者均p = 0.031）和亚临床（两者均p = 0.004）甲状腺功能减退病例的QUICKI较低而HOMA-IR较高，而亚临床（p = 0.039）但接受治疗的甲状腺功能减退病例（p = 0.365）的甘油三酯/HDL胆固醇比值较高。接受治疗的甲状腺功能减退患者比甲状腺功能正常的患者更常患有高血压（n = 11 [75%]）（n = 36 [37%]）（p = 0.008）。三组之间在其他特征方面未发现差异。在控制了潜在的混杂变量后，亚临床甲状腺功能减退仍然独立预测HOMA-IR和QUICKI（p≤0.06），而接受治疗的甲状腺功能减退则不然（p = 0.2）。在RA中，亚临床甲状腺功能减退很常见，并且与胰岛素抵抗及其相关的血脂异常有关。在未来旨在明确RA患者CV风险的研究中应考虑评估甲状腺功能。
