Wang Haoyu, Liu Aihua, Zhou Yingying, Xiao Yue, Yan Yumeng, Zhao Tong, Gong Xun, Pang Tianxiao, Fan Chenling, Zhao Jiajun, Teng Weiping, Shan Zhongyan, Lai Yaxin
Department of Endocrinology and Metabolism, Institute of Endocrinology, Liaoning Provincial Key Laboratory of Endocrine Diseases, The First Affiliated Hospital of China Medical University, China Medical University, Shenyang, Liaoning Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong University Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong, China.
Medicine (Baltimore). 2017 Sep;96(39):e8163. doi: 10.1097/MD.0000000000008163.
Elevated free thyroxine (FT4) levels may play a protective role in development of dyslipidemia. However, few prospective studies have been performed to definite the effects of thyroid hormones on the improvement of dyslipidemia and its components. Thus, this study aims to clarify the association between thyroid hormones within normal range and reversal of dyslipidemia in the absence of intervention.A prospective analysis including 134 adult males was performed between 2010 and 2014. Anthropometric parameters, thyroid function, and lipid profile were measured at baseline and during follow-up. Logistic regression and receiver operating characteristic (ROC) analysis were conducted to identify the variables in forecasting the reversal of dyslipidemia and its components.During 4.5-year follow-up, 36.6% (49/134) patients resolved their dyslipidemia status without drug intervention. Compared with the continuous dyslipidemia group, subjects in reversal group had elevated FT4 and high-density lipoprotein cholesterol (HDL-C) levels, as well as decreased total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) levels at baseline. Furthermore, baseline FT4 is negatively associated with the change percentages of TG (r = -0.286, P = .001), while positively associated with HDL-C (r = 0.227, P = .008). However, no correlation of lipid profile change percentages with FT3 and TSH were observed. Furthermore, the improving effects of baseline FT4 on dyslipidemia, high TG, and low HDL-C status were still observed after multivariable adjustment. In ROC analysis, areas under curve (AUCs) for FT4 in predicting the reversal of dyslipidemia, high TG, and low HDL-C were 0.666, 0.643, and 0.702, respectively (P = .001 for dyslipidemia, .018 for high TG, and .001 for low HDL-C).Higher FT4 value within normal range may ameliorate the dyslipidemia, especially high TG and low HDL-C status, in males without drug intervention. This suggests that a more flexible lipid-lowering therapy may be appropriate for patients with high-normal FT4.
游离甲状腺素（FT4）水平升高可能在血脂异常的发生发展中起保护作用。然而，很少有前瞻性研究来确定甲状腺激素对改善血脂异常及其组分的影响。因此，本研究旨在阐明在无干预情况下，正常范围内的甲状腺激素与血脂异常逆转之间的关联。
在2010年至2014年期间，对134名成年男性进行了一项前瞻性分析。在基线和随访期间测量人体测量参数、甲状腺功能和血脂谱。进行逻辑回归和受试者工作特征（ROC）分析，以确定预测血脂异常及其组分逆转的变量。
在4.5年的随访期间，36.6%（49/134）的患者在未进行药物干预的情况下血脂异常状况得到缓解。与持续血脂异常组相比，逆转组受试者在基线时FT4和高密度脂蛋白胆固醇（HDL-C）水平升高，总胆固醇（TC）、甘油三酯（TG）和低密度脂蛋白胆固醇（LDL-C）水平降低。此外，基线FT4与TG的变化百分比呈负相关（r = -0.286，P = 0.001），而与HDL-C呈正相关（r = 0.227，P = 0.008）。然而，未观察到血脂谱变化百分比与FT³和促甲状腺激素（TSH）之间的相关性。此外，在多变量调整后，仍观察到基线FT4对血脂异常、高TG和低HDL-C状态的改善作用。在ROC分析中，FT4预测血脂异常逆转、高TG和低HDL-C的曲线下面积（AUC）分别为0.666、0.643和0.702（血脂异常P = 0.001，高TG P = 0.018，低HDL-C P = 0.001）。
正常范围内较高的FT4值可能改善男性在未进行药物干预情况下的血脂异常，尤其是高TG和低HDL-C状态。这表明对于FT4处于略高水平的患者，可能适合采用更灵活的降脂治疗。
