不同程度亚临床甲状腺功能减退症患者止凝血相关指标变化的研究

doi:10.3969/j.issn.1673-8640.2018.02.004

摘要/Abstract

摘要：

目的探讨不同程度亚临床甲状腺功能减退症（SH）患者止凝血相关指标的变化。方法选择95例初次诊断为SH患者和54名健康志愿者（正常对照组）为研究对象,根据促甲状腺激素（TSH）水平将患者分为2个组,A组（轻度SH组）4.2 μIU/mL<TSH<10 μIU/mL,B组（重度SH组）TSH≥10 μIU/mL;比较甲状腺功能、代谢综合症组分及止凝血相关指标,并进行统计学分析。结果 B组患者纤维蛋白原（Fib）、纤溶酶原激活物抑制物1（PAI-1）、纤溶酶原激活物（t-PA）水平高于正常对照组（P<0.05）,活化部分凝血活酶时间（APTT）、D-二聚体（DD）水平低于正常对照组（P<0.05）;A组患者止凝血指标正常,与对照组相比无明显差异（P>0.05）;相关分析显示APTT（r值分别为0.077、0.433和0.597）、Fib（r值分别为0.093、- 0.166和0.201）、DD（r值分别为0.268、-0.382和0.205）、PAI-1（r值分别为0.034、0.221和0.003）、t-PA（r值分别为0.198、-0.471和0.145）与游离三碘甲状腺原氨酸（FT3）、血清游离甲状腺素（FT4）、TSH无相关性。结论重度SH患者Fib、PAI-1、t-PA水平升高,DD水平降低,APTT缩短,提示凝血功能减退,处于高凝状态,有潜在的血栓形成倾向,合并心血管疾病风险增大。

关键词: 亚临床甲状腺功能减退症, 止凝血指标, 高凝状态

Abstract:

Objective To investigate the changes of haemostatic parameters in patients with different levels of subclinical hypothyroidism（SH）. Methods A total of 95 patients with SH and 54 healthy subjects were enrolled. SH patients were classified into 2 groups according to thyroid-stimulating hormone（TSH） levels,and there were group A（mild SH group）（4.2 μIU/mL<TSH<10 μIU/mL） and group B（severe SH group）（TSH≥10 μIU/mL）. Thyroid function,metabolic syndrome and haemostatic parameters were compared and analyzed statistically. Results The levels of fibrinogen（Fib）,plasminogen activator inhibitor-1（PAI-1） and tissue plasminogen activator（t-PA） in group B were higher than those in healthy control group（P<0.05）,and activated partial thromboplastin time（APTT） and D-dimer（DD） were lower（P<0.05）. No statistical significance for haemostatic parameters was found between group A and healthy control group（P>0.05）. Serum free triiodothyronine（FT3）,free thyroxine（FT4） and TSH were not correlated with APTT（r=0.077,0.443 and 0.597）,Fib（r=0.093,-0.166 and 0.201）,DD（r=0.268,-0.382 and 0.205）,PAI-1（r=0.034,0.221 and 0.003）and t-PA（r=0.198,-0.471 and 0.145）. Conclusions The increasing of Fib,PAI-1 and t-PA and the decreasing of DD and APTT in severe SH group may lead to the occurrence of cardiovascular diseases.

Key words: Subclinical hypothyroidism, Haemostatic parameters, Hypercoagulability

中图分类号:

R446.1

高芳, 张云娜, 赵乃蕊, 李翠柳, 杨馨鑫. 不同程度亚临床甲状腺功能减退症患者止凝血相关指标变化的研究[J]. 检验医学, 2018, 33(2): 110-114.

GAO Fang, ZHANG Yunna, ZHAO Nairui, LI Cuiliu, YANG Xinxin. Changes of haemostatic parameters in patients with different levels of subclinical hypothyroidism[J]. Laboratory Medicine, 2018, 33(2): 110-114.

图/表 2

参考文献 20

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组别	例数	年龄（岁）	体重指数（kg/m²）	吸烟	TSH （µIU/mL）	FT3 （pg/mL）	FT4 （ng/L）	收缩压（kPa）	舒张压（kPa）
正常对照组	54	52.11±8.73	25.47±2.50	11（20.37）	1.65±0.71	3.20±0.44	12.40±1.70	16.25±1.32	10.63±0.64
SH A组	53	55.77±10.12	24.95±2.85	15（28.30）	6.18±1.63	2.95±0.49	11.80±1.90	16.38±1.34	10.66±0.68
SH B组	42	55.7±5.44	25.26±2.77	10（23.81）	13.29±2.57	2.90±0.46	12.50±1.90	16.54±1.91	10.77±0.34
统计值		0.965	0.179	0.922	18.722	2.145	0.721	0.121	0.183
P值		0.388	0.836	0.631	0.000	0.127	0.491	0.886	0.833
组别	TC （mmol/L）	TG （mmol/L）	LDL-C （mmol/L）	HDL-C （mmol/L）	FBG （mmol/L）	UA （µmol/L）	PLT （×10⁹/L）
正常对照组	4.07±0.63	1.10±0.39	2.39±0.48	1.09±0.15	4.94±0.57	229.94±41.46	238.72±31.18
SH A组	5.04±1.10	1.48±0.73	3.09±0.83	1.04±0.21	4.91±0.65	267.40±82.50	239.27±30.38
SH B组	4.90±0.63	1.88±0.96	2.87±0.63	1.00±0.36	4.56±0.33	301.10±65.17	236.60±54.17
统计值	6.564	4.287	5.147	0.594	1.619	3.836	0.019
P值	0.003	0.019	0.010	0.556	0.209	0.029	0.981
组别	MPV （fL）	PDW （%）	APTT（s）	PT（s）	Fib （g/L）	PAI-1 （ng/mL）	t-PA （ng/mL）	DD （µg/mL）
正常对照组	10.75±1.93	12.66±1.44	26.19±2.97	11.20±0.67	2.67±0.59	25.77±8.17	5.43±1.99	0.73±0.29
SH A组	10.84±1.86	12.72±1.39	24.91±2.17	11.49±1.10	2.89±0.71	25.80±8.08	5.80±2.10	0.77±0.29
SH B组	12.45±0.91	13.73±0.79	22.57±6.04	11.27±1.28	3.39±0.56	32.46±3.98	7.62±1.63	0.44±0.10
统计值	5.577	3.812	3.775	0.428	5.732	4.904	6.174	8.787
P值	0.006	0.028	0.029	0.654	0.006	0.011	0.004	0.001

组别	例数	年龄（岁）	体重指数（kg/m²）	吸烟	TSH （µIU/mL）	FT3 （pg/mL）	FT4 （ng/L）	收缩压（kPa）	舒张压（kPa）
正常对照组	54	52.11±8.73	25.47±2.50	11（20.37）	1.65±0.71	3.20±0.44	12.40±1.70	16.25±1.32	10.63±0.64
SH A组	53	55.77±10.12	24.95±2.85	15（28.30）	6.18±1.63	2.95±0.49	11.80±1.90	16.38±1.34	10.66±0.68
SH B组	42	55.7±5.44	25.26±2.77	10（23.81）	13.29±2.57	2.90±0.46	12.50±1.90	16.54±1.91	10.77±0.34
统计值		0.965	0.179	0.922	18.722	2.145	0.721	0.121	0.183
P值		0.388	0.836	0.631	0.000	0.127	0.491	0.886	0.833
组别	TC （mmol/L）	TG （mmol/L）	LDL-C （mmol/L）	HDL-C （mmol/L）	FBG （mmol/L）	UA （µmol/L）	PLT （×10⁹/L）
正常对照组	4.07±0.63	1.10±0.39	2.39±0.48	1.09±0.15	4.94±0.57	229.94±41.46	238.72±31.18
SH A组	5.04±1.10	1.48±0.73	3.09±0.83	1.04±0.21	4.91±0.65	267.40±82.50	239.27±30.38
SH B组	4.90±0.63	1.88±0.96	2.87±0.63	1.00±0.36	4.56±0.33	301.10±65.17	236.60±54.17
统计值	6.564	4.287	5.147	0.594	1.619	3.836	0.019
P值	0.003	0.019	0.010	0.556	0.209	0.029	0.981
组别	MPV （fL）	PDW （%）	APTT（s）	PT（s）	Fib （g/L）	PAI-1 （ng/mL）	t-PA （ng/mL）	DD （µg/mL）
正常对照组	10.75±1.93	12.66±1.44	26.19±2.97	11.20±0.67	2.67±0.59	25.77±8.17	5.43±1.99	0.73±0.29
SH A组	10.84±1.86	12.72±1.39	24.91±2.17	11.49±1.10	2.89±0.71	25.80±8.08	5.80±2.10	0.77±0.29
SH B组	12.45±0.91	13.73±0.79	22.57±6.04	11.27±1.28	3.39±0.56	32.46±3.98	7.62±1.63	0.44±0.10
统计值	5.577	3.812	3.775	0.428	5.732	4.904	6.174	8.787
P值	0.006	0.028	0.029	0.654	0.006	0.011	0.004	0.001