陈涛　石秀娥　柳灵

[摘要] 目的 探讨甲状腺功能异常患者血小板参数和凝血指标的变化及其临床意义。 方法 选择2014年1月～2017年9月在甘肃省康复中心医院（以下简称“我院”）住院部和门诊就诊的甲状腺功能异常患者120例，根据血清中促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）水平分为甲状腺功能亢进组（甲亢组）和甲状腺功能减退组（甲减组），每组各60例，并选择同期来我院健康体检者60例作为对照组。观察比较三组患者血清中TSH、FT3、FT4水平及血小板参数[血小板计数（PLT）、大血小板比率（P-LCR）、血小板分布宽度（PDW）]、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、纤维蛋白原（FIB）水平的变化。 结果 三组人群PLT计数值差异无统计学意义（P > 0.05）；甲亢组PDW、P-LCR和FIB含量均高于对照组及甲减组，差异有统计学意义（P < 0.05）；甲亢组APTT、PT水平明显低于对照组及甲减组，差异有统计学意义（P < 0.05）。 结论 甲亢患者凝血功能处于高凝状态，有继发血栓形成倾向，甲减患者凝血功能减退，有出血危险。

[关键词] 甲状腺功能；凝血功能；异常

[中图分类号] R581 [文献标识码] A [文章编号] 1673-7210（2018）07（b）-0105-04

[Abstract] Objective To study the alteration and the value of platelet parameters and the blood clotting parameters in hypothyroidism patients. Methods Total of 120 patients with abnormal thyroid function were selected from January 2014 to September 2017 in Inpatient Department and Outpatient Clinic of Gansu Rehabilitation Center Hospital（“our hospital” for short）. According to serum TSH， FT3， and FT4 levels， the patients were divided into the hyperthyroidism group consisted of 60 patients and hypothyroidism group consisted of 60 patients. In the same period， 60 healthy were selected as the control group. The levels of TSH， FT3， FT4 and platelet parameters （PLT， P-LCR， PDW） and prothrombin time （PT）， activation partial thrombin time （APTT）， fibrinogen （FIB） were observed in the three groups. Results There was no difference in PLT value among the three groups （P > 0.05）. The contents of PDW， P-LCR and FIB in hyperthyroidism group were higher than those in the hypothyroidism group and the control group， the differences were statistically significant （P < 0.05）. APTT and PT levels of hyperthyroidism group were obviously lower than those in the hypothyroidism group and the control group， with statistically significant differences （P < 0.05）. Conclusion The coagulation function of patients with hyperthyroidism is in high coagulation state， which has a tendency of secondary thrombosis， and the coagulation function of patients with hypothyroidism is reduced and there is a risk of bleeding.

[Key words] Thyroid function； Coagulation function； Abnormality

甲状腺功能异常临床可表现为甲状腺功能亢进（甲亢）和甲状腺功能减退（甲减）等不同形式，常伴有凝血功能指标的异常，易发生出血或血栓倾向[1]。甲亢患者的甲状腺素分泌增多，引发机体心血管系统、循环系统等系统出现一系列高代谢症候群。甲亢患者的凝血、抗凝以及纖溶等系统均存在不同程度的异常，出现凝血功能指标增高，容易诱发血栓形成[2-3]。甲减患者血清促甲状腺激素（TSH）水平增高但血清中游离的三碘甲状腺原氨酸（FT3）及游离甲状腺素（FT4）浓度正常，临床表现因程度不同而不一样。甲减患者凝血功能减退，有出血的危险，最近研究指出，对于甲减患者及TSH水平大于10.0 μU/mL的重度亚临床甲减患者，其发生心血管疾病的概率大大升高，导致心血管疾病的发病率和病死率均升高[4-5]。本……