甲状腺功能减退患者中同型半胱氨酸与低密度脂蛋白胆固醇之间潜在的有害关联。
Potential harmful correlation between homocysteine and low-density lipoprotein cholesterol in patients with hypothyroidism.
作者信息
Dong Xuejie, Yao Zhi, Hu Yanjin, Yang Ning, Gao Xia, Xu Yuan, Wang Guang
机构信息
Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China.
出版信息
Medicine (Baltimore). 2016 Jul;95(29):e4291. doi: 10.1097/MD.0000000000004291.
OBJECTIVE
Hypothyroidism (HO) can induce metabolic dysfunctions related to insulin resistance and dyslipidemia. Our previous studies showed that homocysteine (Hcy) impaired the coronary endothelial function and that Hcy can promote chemokine expression and insulin resistance (IR) by inducing endoplasmic reticulum stress in human adipose tissue and hypothyroid patients. The aim of this study was to investigate the potential harmful correlation between plasma Hcy and low-density lipoprotein cholesterol (LDL-C) in patients with HO.
METHODS
A total of 286 subjects were enrolled. All subjects were divided into the following 3 groups: HO group, subclinical hypothyroidism (SHO) group, and control group. Statistical analyses were carried out to evaluate the correlation between the plasma levels of Hcy and LDL-C in HO patients. The changes in the plasma Hcy levels and other metabolic parameters were measured before and after levothyroxine (L-T4) treatment. The relationship between the changes in the plasma Hcy level and the LDL-C level was also evaluated after L-T4 treatment.
RESULTS
In the patients with HO, both the plasma Hcy and LDL-C levels were significantly higher than those of the controls. The plasma levels of Hcy were positively correlated with the LDL-C level in the HO group. L-T4 treatment resulted in a significant decrease in the BMI, total cholesterol (TC), LDL-C, triglycerides (TG), apolipoprotein B (ApoB), and Hcy levels. Moreover, the decrease in Hcy (ΔHcy) was positively correlated with decreased LDL-C (ΔLDL-C) levels after L-T4 treatment in HO patients.
CONCLUSION
Our results suggest that the increased Hcy level was positively correlated with the LDL-C in the HO group. A potential harmful interaction may exist between Hcy and LDL-C under the HO condition. In addition to reducing the plasma levels of Hcy, L-T4 treatment exerts beneficial effects on patients with HO by improving dyslipidemia, including a decrease in the LDL-C level.
目的
甲状腺功能减退症（甲减）可引发与胰岛素抵抗和血脂异常相关的代谢功能障碍。我们之前的研究表明，同型半胱氨酸（Hcy）会损害冠状动脉内皮功能，并且Hcy可通过诱导人脂肪组织和甲减患者的内质网应激来促进趋化因子表达和胰岛素抵抗（IR）。本研究的目的是调查甲减患者血浆Hcy与低密度脂蛋白胆固醇（LDL-C）之间潜在的有害关联。
方法
共纳入286名受试者。所有受试者被分为以下3组：甲减组、亚临床甲减（SHO）组和对照组。进行统计分析以评估甲减患者血浆Hcy水平与LDL-C之间的相关性。在左甲状腺素（L-T4）治疗前后测量血浆Hcy水平及其他代谢参数的变化。L-T4治疗后还评估了血浆Hcy水平变化与LDL-C水平之间的关系。
结果
在甲减患者中，血浆Hcy和LDL-C水平均显著高于对照组。甲减组血浆Hcy水平与LDL-C水平呈正相关。L-T4治疗导致体重指数（BMI）、总胆固醇（TC）、LDL-C、甘油三酯（TG）、载脂蛋白B（ApoB）和Hcy水平显著降低。此外，甲减患者L-T4治疗后Hcy的降低量（ΔHcy）与LDL-C的降低量（ΔLDL-C）水平呈正相关。
结论
我们的结果表明，甲减组中Hcy水平升高与LDL-C呈正相关。在甲减状态下，Hcy与LDL-C之间可能存在潜在的有害相互作用。除了降低血浆Hcy水平外，L-T4治疗通过改善血脂异常（包括降低LDL-C水平）对甲减患者产生有益影响。
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