背景:甲状腺功能减退症是与血脂异常相关的最常见的代谢紊乱之一,在此类患者中,其导致冠状动脉疾病(CAD)的风险更高。可以迅速承担风险的生化标记现在变得必不可少,因此,超出常规脂质分布的评估是小时的需要。
目的:评估非常规脂质参数如低密度脂蛋白(sdLDL)的相关性,氧化低密度脂蛋白(oxLDL),载脂蛋白A(ApoA1),甲状腺功能减退患者的载脂蛋白B(ApoB)和脂蛋白(a){Lp(a)},并将它们的值与常规脂质参数(如总胆固醇(TC))进行比较,甘油三酯(TG),低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)。
方法:本病例对照研究包括130名年龄在20-60岁的临床证实的甲状腺功能减退症患者以及相同数量的年龄和性别匹配的健康个体。血清SDLDL,oxLDL,ApoA1,ApoB,Lp(a),血脂谱,促甲状腺激素(TSH),两组均测定游离三碘甲状腺原氨酸(FT3)和游离四碘甲状腺原氨酸(FT4)水平。数据在SPSS系统上进行记录和分析。通过学生t检验和单因素方差分析比较病例和对照结果。所有参数均与TSH的Pearson相关。
结果:我们发现sdLDL水平显著升高,oxLDL,ApoB,Lp(a),TC,TG,与对照相比,病例中的LDL-C。OxLDL显示出与血清TSH的最大相关性(p<0.0001,r=0.801),其次是sdLDL(p<0.0001,r=0.792),载脂蛋白B(p<0.001,r=0.783)和LDL-C(p<0.001,r=0.741)。此外,在正常血脂性甲状腺功能减退患者中,发现oxLDL和sdLDL升高,从而提供了强有力的支持性证据,表明对这些参数的估计可以成为迅速识别甲状腺功能减退人群中CAD高危患者的基础。
结论:非常规脂质参数似乎是评估甲状腺功能减退症心血管风险的更好指标,可能有助于临床医生和研究人员设计有效的治疗方案和干预领域。
BACKGROUND: Hypothyroidism is one of the most common metabolic disorders associated with dyslipidemia which poses a higher risk of Coronary Artery Disease (CAD) in such patients. Biochemical markers which can pick up the risk promptly are becoming imperative now-a-days and thus the assessment beyond the conventional lipid profile is the need of the hour.
OBJECTIVE: To assess the association of non-conventional lipid parameters like small dense Low Density Lipoprotein (sd LDL),
oxidized Low Density Lipoprotein (ox LDL), Apolipoprotein A (Apo A1), Apolipoprotein B (Apo B) and Lipoprotein (a) {Lp(a)} in hypothyroid patients and compare their values with the conventional lipid parameters such as Total Cholesterol (TC), Triglyceride (TG), Low-Density Lipoprotein Cholesterol (LDL-C) and High-Density Lipoprotein Cholesterol (HDL-C).
METHODS: One hundred and thirty clinically proven patients of hypothyroidism aged 20-60 years and equal number of age and gender matched healthy individuals were included in this case control study. Serum sd LDL, ox LDL, Apo A1, Apo B, Lp (a), lipid profile, Thyroid Stimulating Hormone (TSH), Free Triiodothyronine (FT3) and Free Tetraiodothyronine (FT4) levels were measured in both the groups. The data was recorded and analysed on SPSS system. The results of cases and controls were compared by student t-test and one-way ANOVA. All the parameters were correlated with TSH by Pearson\'s correlation.
RESULTS: We found significantly high levels of sd LDL, ox LDL, Apo B, Lp (a), TC, TG, LDL-C in cases as compared to the controls. Ox LDL has shown maximum correlation with serum TSH (p<0.0001, r=0.801) followed by sd LDL (p<0.0001, r=0.792), Apo B (p<0.001, r=0.783) and LDL-C (p<0.001, r=0.741). Moreover, ox LDL and sd LDL were found to be increased in normolipidemic hypothyroid patients thereby giving a strong supportive evidence that estimation of these parameters can become fundamental in prompt identification of the high risk patients of CAD in hypothyroid population.
CONCLUSIONS: Non-conventional lipid parameters appear to be better markers for the assessment of cardiovascular risk in hypothyroidism and might help in the designing of the effective treatment protocols and areas of intervention by the clinicians as well as researchers.