Stojković Mirjana, Nedeljković-Beleslin Biljana, Tešić Milorad, Bukumirić Zoran, Ćirić Jasmina, Stojanović Miloš, Miletić Marija, Đorđević-Dikić Ana, Giga Vojislav, Beleslin Branko, Žarković Miloš
University of Belgrade, Faculty of Medicine, Belgrade.
J Med Biochem. 2022 Jul 29;41(3):299-305. doi: 10.5937/jomb0-34545.
Although thyroid hormones have significant effect on cardiovascular system, the impact of subtle thyroid dysfunction such as subclinical hypothyroidism (SCH) remains to be determined. We investigated coronary flow reserve (CFR) in patients with subclinical hypothyroidism.
Thirty two subjects with SCH and eighteen control subjects with normal serum thyroid hormones and thyroid-stimulating hormone (TSH) levels were included in the study. TSH, free thyroxine, free triiodothyronine, glucose, insulin, HbA1c, cholesterol, triglyceride and plasma levels of C-reactive protein were measured. Coronary diastolic peak flow velocities in left anterior descending coronary artery were measured at baseline and after adenosine infusion. CFR was calculated as the ratio of hyperemic to baseline diastolic peak velocity.
CFR values were not significantly different between the two groups (SCH 2.76±0.35 vs controls 2.76±0.42). There was a significant correlation of CFR with waist to hip ratio, hypertension, smoking habits, markers of glucose status (glucose level, HbA1c, insulin level, HOMA IR), cholesterol, LDL-cholesterol and triglyceride levels in SCH group, whereas only cholesterol level showed significant correlation with CFR in controls. There was no correlation between CFR and thyroid hormones.
We concluded that there is a different impact of cardiovascular risk factors on CFR in SCH patients compared to healthy control and that these two groups behave differently in the same circumstances under the same risk factors. The basis for this difference could be that the altered thyroid axis "set point" changes the sensitivity of the microvasculature in patients with SCH to known risk factors.
尽管甲状腺激素对心血管系统有显著影响，但亚临床甲状腺功能减退（SCH）等轻微甲状腺功能障碍的影响仍有待确定。我们研究了亚临床甲状腺功能减退患者的冠状动脉血流储备（CFR）。
本研究纳入了32例亚临床甲状腺功能减退患者和18例血清甲状腺激素及促甲状腺激素（TSH）水平正常的对照受试者。测量了TSH、游离甲状腺素、游离三碘甲状腺原氨酸、葡萄糖、胰岛素、糖化血红蛋白、胆固醇、甘油三酯和C反应蛋白的血浆水平。在基线和腺苷输注后测量左前降支冠状动脉的冠状动脉舒张期峰值流速。CFR计算为充血期与基线舒张期峰值流速之比。
两组之间的CFR值无显著差异（亚临床甲状腺功能减退组为2.76±0.35，对照组为2.76±0.42）。在亚临床甲状腺功能减退组中，CFR与腰臀比、高血压、吸烟习惯、血糖状态标志物（血糖水平、糖化血红蛋白、胰岛素水平、稳态模型评估胰岛素抵抗）、胆固醇、低密度脂蛋白胆固醇和甘油三酯水平显著相关，而在对照组中，仅胆固醇水平与CFR显著相关。CFR与甲状腺激素之间无相关性。
我们得出结论，与健康对照组相比，心血管危险因素对亚临床甲状腺功能减退患者CFR的影响不同，并且在相同风险因素下，这两组在相同情况下表现不同。这种差异的基础可能是甲状腺轴“设定点”的改变改变了亚临床甲状腺功能减退患者微血管对已知危险因素的敏感性。
