重组人促甲状腺素可改善甲状腺切除术后分化型甲状腺癌患者的冠状动脉血流储备。

Recombinant Human Thyrotropin Improves Endothelial Coronary Flow Reserve in Thyroidectomized Patients with Differentiated Thyroid Cancer.

作者信息

Ippolito Serena, Ippolito Renato, Peirce Carmela, Esposito Roberta, Arpaia Debora, Santoro Ciro, Pontieri Gilda, Cocozza Sara, Galderisi Maurizio, Biondi Bernadette

机构信息

1 Department of Clinical Medicine and Surgery, University of Naples Federico II , Naples, Italy .

2 Department of Advanced Biomedical Science, University of Naples Federico II , Naples, Italy .

出版信息

Thyroid. 2016 Nov;26(11):1528-1534. doi: 10.1089/thy.2016.0082. Epub 2016 Oct 14.

DOI:10.1089/thy.2016.0082

PMID:27558484

Abstract

BACKGROUND

The role of thyrotropin (TSH) on the cardiovascular system has been poorly investigated. It is unknown whether the changes in the vasculature associated with thyroid diseases result from altered thyroid hormone action or whether they are a consequence of a direct effect of TSH on endothelial cells. The present study was designed to evaluate the endothelial response of coronary flow to TSH in patients with differentiated thyroid cancer (DTC) without cardiovascular risk factors.

METHODS

The study population consisted of three men and seven women (M = 32.6 ± 8 years) who underwent total thyroidectomy for DTC. All were receiving therapy with L-thyroxine to maintain TSH within the reference range. No patient was obese, or had hypertension, diabetes, or dyslipidemia. Patients underwent standard echo-Doppler examination with evaluation of the coronary flow reserve (CFR) of the distal left anterior descending artery obtained by cold pressure test (CPT) before and 24 h after the second recombinant human TSH (rhTSH) injection.

RESULTS

Left ventricular morphology and systolic and diastolic function were normal in all patients. Levels of thyroid hormones and thyroglobulin and antithyroglobulin antibodies did not differ significantly pre- versus post-rhTSH treatment, whereas TSH levels were higher after rhTSH administration. Blood pressure and heart rate were not affected by rhTSH. Coronary flow peak velocity at rest (22.3 ± 6 vs 23.2 ± 8.7; p = 0.66) did not differ between baseline and 24 h after rhTSH, while post-CPT velocity (29.3 ± 6.8 vs 34.4 ± 10.9; p < 0.05) and the CFR were higher after rhTSH administration (1.32 ± 0.2 vs. 1.53 ± 0.2; p < 0.01).

CONCLUSIONS

rhTSH administration may improve the CFR after the non-pharmacological stressor CPT in DTC patients. The increase of coronary blood flow after rhTSH suggests that TSH may exert a protective effect on the coronary endothelium.

摘要

背景

促甲状腺激素（TSH）对心血管系统的作用研究较少。目前尚不清楚与甲状腺疾病相关的血管变化是由甲状腺激素作用改变引起的，还是TSH对内皮细胞直接作用的结果。本研究旨在评估无心血管危险因素的分化型甲状腺癌（DTC）患者中冠状动脉血流对TSH的内皮反应。

方法

研究人群包括3名男性和7名女性（平均年龄32.6±8岁），他们因DTC接受了甲状腺全切术。所有患者均接受左甲状腺素治疗以将TSH维持在参考范围内。没有患者肥胖、患有高血压、糖尿病或血脂异常。患者在第二次注射重组人TSH（rhTSH）之前和之后24小时接受标准超声多普勒检查，通过冷压试验（CPT）评估左前降支远端的冠状动脉血流储备（CFR）。

结果

所有患者的左心室形态、收缩和舒张功能均正常。rhTSH治疗前后甲状腺激素、甲状腺球蛋白和抗甲状腺球蛋白抗体水平无显著差异，而rhTSH给药后TSH水平较高。血压和心率不受rhTSH影响。静息时冠状动脉血流峰值速度（22.3±6与23.2±8.7；p = 0.66）在基线和rhTSH后24小时之间无差异，而CPT后速度（29.3±6.8与34.4±10.9；p < 0.05）和CFR在rhTSH给药后更高（1.32±0.2与1.53±0.2；p < 0.01）。