于立芹

[摘要] 目的 探讨左旋甲状腺素治疗亚临床甲减的疗效及对血脂的影响。 方法 选取2016年1月～2017年1月在我院住院治疗的亚临床甲减患者60例，所有患者根据治疗方法不同随机分为观察组和对照组，每组各30例，对照组根据患者主诉，如乏力、怕冷、浮肿、便秘等进行对症治疗；观察组予以左旋甲状腺素钠1 μg/（kg·d）口服治疗，连续治疗3个月。治疗后比较两组的甲状腺激素及血脂各项指标、临床疗效。 结果 治疗后，观察组、对照组患者的FT3、FT4水平较治疗前明显降低，TSH水平较治疗明显提高，且观察组较对照组变化更显著（P<0.05），观察组、对照组的TC、TG及LDL-C水平较治疗前显著降低，而HDL-C水平显著升高，且观察组患者的TC、TG、HDL-C及LDL-C水平较对照组改善更显著（P<0.05），两组患者治疗后的总有效率分别为96.7%、70.0%，观察组的总有效率明显高于对照组（P<0.05）。 结论 左旋甲状腺素治疗亚临床甲减疗效确切，能显著降低血脂水平。

[关键词] 亚临床甲减；左旋甲状腺素；血脂；TSH

[中图分类号] R581.2 [文献标识码] B [文章编号] 1673-9701（2018）21-0107-03

[Abstract] Objective To investigate the therapeutic effect of levothyroxine on subclinical hypothyroidism and its effect on serum lipids. Methods Sixty patients with subclinical hypothyroidism who were hospitalized in our hospital from January 2016 to January 2017 were selected. All patients were randomly divided into observation group and control group according to different treatment methods. Each group had 30 cases. The patients in control group took treatment according to their complain of fatigue， cold， edema， constipation and other symptomatic； observation group underwent continuous levothyroxine sodium 1 μg/（kg·d） orally for 3 months. After treatment， the thyroid hormones and blood lipids were compared between the two groups in terms of clinical efficacy. Results After treatment， the levels of FT3 and FT4 in the observation group and the control group were significantly lower than those before treatment， and TSH levels were significantly higher than those in the control group（P<0.05）. The TC， TG and LDL-C levels in the observation group and the control group were significantly lower than those before treatment， while HDL-C levels were significantly increased， and TC， TG， HDL-C and LDL-C levels in the observation group improved more significantly than those in the control group（P<0.05）. The total effective rates of the two groups after treatment were 96.7% and 70.0% respectively. The total effective rate in the observation group was significantly higher than that in the control group（P<0.05）. Conclusion L-thyroxine treatment of subclinical hypothyroidism has a definite curative effect and can significantly reduce the level of blood lipids.

[Key words] Subclinical hypothyroidism； Levothyroxine； Lipids； TSH

亞临床甲减是内分泌科的常见病、多发病，甲状腺激素替代治疗为亚临床甲减的主要治疗方法，研究证实，其对于改善甲状腺激素水平，防止甲状腺进一步代偿性肿大具有重要作用[1-2]。左旋甲状腺素为人工合成的四碘甲状腺原氨酸的钠盐，适用于甲状腺激素的替代治疗[3]，本研究旨在探讨左旋甲状腺素治疗亚临床甲减的疗效及对血脂的影响，现报道如下。

1 资料与方法

1.1临床资料

选取2016年1月～2017年1月在我院住院治疗的亚临床甲减患者60例，符合甲状腺功能减退诊断标准[3]：具备甲减低代谢的临床表现，甲状腺功能测定游离三碘甲腺原氨酸（FT3）、游离甲状腺素（FT4）减低，促甲状腺激素（TSH）增高。排除合并严重肝肾功能不全及精神疾病者[4]。患者家属均对本研究知情同意，并签署知情同意书。……