亚临床甲状腺功能减退症患者的脂蛋白和载脂蛋白水平。左甲状腺素治疗的效果。

Lipoprotein and apolipoprotein levels in subclinical hypothyroidism. Effect of levothyroxine therapy.

作者信息

Arem R, Patsch W

机构信息

Division of Endocrinology and Metabolism, Baylor College of Medicine, Houston, TX 77030.

出版信息

Arch Intern Med. 1990 Oct;150(10):2097-100.

PMID:2222095

Abstract

To assess whether subclinical hypothyroidism is associated with changes in lipoprotein fractions, 13 patients maintained in a stable state of subclinical hypothyroidism for at least 3 months were studied prior to and 2 and 4 months following restoration of a euthyroid state with incremental levothyroxine sodium therapy. Thyrotropin levels ( +/- SEM) had decreased from 16.6 +/- 3.2 mU/L to 3.1 +/- 0.7 mU/L and 3.2 +/- 0.7 mU/L at 2 months and 4 months. At 2 months, levothyroxine treatment led to a decrease in levels of total cholesterol from 5.5 +/- 0.3 mmol/L (213 +/- 12 mg/dL) to 4.8 +/- 0.3 mmol/L (186 +/- 12 mg/dL), in low-density lipoprotein cholesterol (LDL-C) from 3.7 +/- 0.3 mmol/L (143 +/- 12 mg/dL) to 2.9 +/- 0.3 mmol/L (112 +/- 12 mg/dL), and in apolipoprotein B from 91 +/- 8 mg/dL to 74 +/- 7 mg/dL. At 4 months, levels of LDL-C and apolipoprotein B remained significantly lower than pretreatment values (2.9 +/- 0.2 mmol/L [112 +/- 8 mg/dL] and 75 +/- 6 mg/dL, respectively). While high-density lipoprotein cholesterol (HDL-C), HDL3-C, and apolipoprotein A-I were not significantly affected by levothyroxine therapy, there was a slight trend of increase in HDL2-C during levothyroxine substitution. There was also a tendency for a decrease in triglyceride levels from 1.3 +/- 0.2 mmol/L (115 +/- 18 mg/dL) to 0.9 +/- 0.1 mmol/L (80 +/- 9 mg/dL) at 4 months of levothyroxine therapy. Levels of HDL-C tended to decrease from 4.8 +/- 0.4 mmol/L (186 +/- 15 mg/dL) to 4.5 +/- 0.5 mmol/L (174 +/- 19 mg/dL) at 2 months and to 3.9 +/- 0.4 mmol/L (151 +/- 15 mg/dL) at 4 months. The LDL-C/HDL-C ratio also decreased from 3.3 +/- 0.3 mmol/L (128 +/- 12 mg/dL) to 2.9 +/- 0.5 mmol/L (112 +/- 19 mg/dL) and 2.5 +/- 0.3 mmol/L (97 +/- 12 mg/dL) at 2 months and 4 months, respectively. These results suggest that long-term levothyroxine therapy in patients with subclinical hypothyroidism is associated with a decrease in LDL-C and apolipoprotein B levels that are reflected in a trend of decreases in cholesterol/HDL-C and LDL-C/HDL-C ratios known to have a relationship with coronary artery disease.

摘要

为评估亚临床甲状腺功能减退症是否与脂蛋白组分变化相关，对13例处于亚临床甲状腺功能减退症稳定状态至少3个月的患者，在采用递增左甲状腺素钠治疗恢复甲状腺功能正常状态之前、之后2个月和4个月进行了研究。促甲状腺激素水平（±标准误）在2个月和4个月时分别从16.6±3.2 mU/L降至3.1±0.7 mU/L和3.2±0.7 mU/L。在2个月时，左甲状腺素治疗使总胆固醇水平从5.5±0.3 mmol/L（213±12 mg/dL）降至4.8±0.3 mmol/L（186±12 mg/dL），低密度脂蛋白胆固醇（LDL-C）从3.7±0.3 mmol/L（143±12 mg/dL）降至2.9±0.3 mmol/L（112±12 mg/dL），载脂蛋白B从91±8 mg/dL降至74±7 mg/dL。在4个月时，LDL-C和载脂蛋白B水平仍显著低于治疗前值（分别为2.9±0.2 mmol/L[112±8 mg/dL]和75±6 mg/dL）。虽然高密度脂蛋白胆固醇（HDL-C）、HDL3-C和载脂蛋白A-I未受到左甲状腺素治疗的显著影响，但在左甲状腺素替代治疗期间HDL2-C有轻微升高趋势。在左甲状腺素治疗4个月时，甘油三酯水平也有从1.3±0.2 mmol/L（115±18 mg/dL）降至0.9±0.1 mmol/L（80±9 mg/dL）的趋势。HDL-C水平在2个月时倾向于从4.8±0.4 mmol/L（186±15 mg/dL）降至4.5±0.5 mmol/L（174±19 mg/dL），在4个月时降至3.9±0.4 mmol/L（151±15 mg/dL）。LDL-C/HDL-C比值在2个月和4个月时也分别从3.3±0.3 mmol/L（128±12 mg/dL）降至2.9±0.5 mmol/L（112±19 mg/dL）和2.5±0.3 mmol/L（97±12 mg/dL）。这些结果表明，亚临床甲状腺功能减退症患者长期接受左甲状腺素治疗与LDL-C和载脂蛋白B水平降低相关，这反映在胆固醇/HDL-C和LDL-C/HDL-C比值降低的趋势上，而这些比值已知与冠状动脉疾病有关。