本文選題：亞臨床甲狀腺功能異常 + 亞臨床甲亢　； 參考：《河北醫(yī)科大學》2015年碩士論文

【摘要】：目的:亞臨床甲狀腺功能異常(Subclinical thyroid dysfunction)包括亞臨床甲狀腺功能亢進癥簡稱亞臨床甲亢(subclinical hyperthyroidism,SH)和亞臨床甲狀腺功能減退癥簡稱亞臨床甲減(subclinical hypothyroidism,SCH),患者血清游離三碘甲狀腺原氨酸(FT3),游離甲狀腺素(FT4)水平正常而血清促甲狀腺激素(TSH)水平異常,臨床癥狀輕微,但由于其潛在的致病傾向,能引起一系列心腦血管并發(fā)癥,如動脈粥樣硬化、高血壓等。如果不及時治療易進展為臨床甲狀腺功能異常,引起機體代謝紊亂,因此近年來備受關注。亞臨床甲狀腺功能異常是超前性預防醫(yī)學的分支,重視亞臨床甲狀腺功能異常,將有利于疾病的超前預防。抵抗素(Resistin)是一種新發(fā)現的脂肪細胞分泌的脂肪因子,參與了代謝疾病如動脈粥樣硬化、糖尿病、胰島素抵抗等疾病的發(fā)生發(fā)展。目前抵抗素與甲狀腺功能異常關系尚無準確定論,與亞臨床甲狀腺功能異常還是空白。本文旨在進一步探討亞臨床甲狀腺功能異常和抵抗素相互關系。高尿酸血癥是指嘌呤代謝紊亂或尿酸排泄障礙引起血尿酸(Uric Acid,URIC,UA)濃度升高所致的疾病。血尿酸升高是高血壓、動脈粥樣硬化、蛋白尿等的獨立危險因素,是心血管疾病的危險因素和胰島素抵抗的重要表現。國內外對于亞臨床甲狀腺功能異常與尿酸的相關性研究尚未見報道,本文旨在研究亞臨床甲狀腺功能異常患者血尿酸水平變化并探討其臨床意義。同型半胱氨酸(Homocysteine,HCY)在心血管疾病的病理生理和預后中起著越來越重要的作用。其可以促進亞臨床甲減,增加動脈粥樣硬化的關系也越來越引起人們重視,而在亞臨床甲亢中的變化研究的還不多,本文旨在探討血漿同型半胱氨酸與甲狀腺功能的相關性,為亞臨床甲狀腺功能異�；颊咛峁┮环N客觀的監(jiān)測指標。亞臨床甲狀腺功能異常時期未采取有效措施治療可近一步誘發(fā)血脂升高、動脈粥樣硬化等并發(fā)癥,因此分析與并發(fā)癥相關的指標顯得尤為重要。本研究擬檢測亞臨床甲狀腺功能異常和健康體檢者血清Resistin、URIC、HCY水平,發(fā)現Resistin、URIC、HCY水平在亞臨床甲狀腺功能異常時的作用,為預防亞臨床甲狀腺功能異�；颊卟l(fā)癥的發(fā)生發(fā)展提供客觀監(jiān)測依據。方法:1研究對象隨機選擇2013年7月至2014年7月未經治療的初診為亞臨床甲狀腺疾病的患者70例,其中亞臨床甲狀腺功能亢進癥32例作為亞臨床甲亢組,其中男12例、女20例,平均年齡(34.4±13.5)歲;亞臨床甲狀腺功能減退癥38例作為亞臨床甲減組,亞臨床甲減患者38例,其中男16例、女22例,平均年齡(39.1±19.6)歲;另隨機選取同一時期健康體檢者72例作為對照組,年齡性別與患者組相匹配。其中男30例、女42例,平均年齡(36.2±15.1)歲。分別用化學發(fā)光免疫分析法測定血清游離三碘甲狀腺原氨酸(FT3),游離甲狀腺素(FT4)促甲狀腺激素(TSH),維生素B12(Vit B12)、葉酸(FA),用ELISA方法測定血清抵抗素(Resistin);用終點速率法測定尿酸(URIC);酶法測定同型半胱氨酸(HCY)。研究三組人群亞臨床甲狀腺功能異常時血清抵抗素、尿酸及血清同型半胱氨酸的水平變化。2實驗方法(1)血清FT3、FT4、TSH、Vit B12、FA檢測:采用化學發(fā)光免疫方法,全部實驗在二級生物安全實驗室進行。(2)血清URIC、HCY、及常規(guī)生化指標CHOL、TG及HDL-C、LDL-C等檢測:采用全自動生化儀在二級生物安全實驗室進行檢測。(3)血清Resistin檢測采用酶聯(lián)免疫雙抗體夾心法,按操作說明書在二級生物安全實驗室進行檢測。使用SPSS 16.0統(tǒng)計學軟件對數據進行處理。計量資料以均數±標準差表示,3組比較采用單因素方差分析,兩指標采用線性相關分析,以P0.05為差異有統(tǒng)計學意義。結果:1三組一般資料比較:亞臨床甲亢組、亞臨床甲減組及對照組三組人群在年齡、性別、BMI、FT3、FT4差異均無統(tǒng)計學意義(P均0.05),2亞臨床甲亢組血清CHOL、LDL水平顯著低于對照組(P0.05),低于亞臨床甲減組(P0.05);亞臨床甲減組患者血清TG、CHOL明顯高于對照組,明顯高于亞臨床甲亢組,差異有統(tǒng)計學意義(P0.05),亞臨床甲減組LDL與正常對照組比較沒有變化但高于亞臨床甲亢組(P0.05),3亞臨床甲亢組與健康對照組相比Resistin升高,差異有統(tǒng)計學意義(P0.05),URIC、HCY比對照組明顯降低,差異有統(tǒng)計學意義(P0.05),Vit B12、FA與對照組比較沒有明顯差異(P0.05)。亞臨床甲減組與健康對照組相比,血清Resistin及FA下降,差異有統(tǒng)計學意義(P0.05);而HCY、URIC明顯升高,差異有統(tǒng)計學意義(P均0.05)。4亞臨床甲亢組、亞臨床甲減組TSH與Resistin呈負相關,r值分別為-0.516(P0.01)、-0.411(P0.05),而亞臨床甲亢組、亞臨床甲減組TSH與HCY成正相關,r值分別為0.495、0.441,P均0.01。結論:血清Resistin、URIC和HCY的變化可能對判斷亞臨床甲狀腺功能異常的診斷療效及疾病的發(fā)展、治療有輔助作用。對預防并發(fā)癥的發(fā)生發(fā)展提供客觀監(jiān)測依據。
[Abstract]:Objective: subclinical thyroid dysfunction (Subclinical thyroid dysfunction) includes subclinical hyperthyroidism (subclinical hyperthyroidism, SH) and subclinical hypothyroidism for short, subclinical hypothyroidism (subclinical hypothyroidism, SCH), and serum free three iodine thyroidic acid (FT3). The level of free thyroxine (FT4) is normal but the level of serum thyrotropin (TSH) is abnormal and its clinical symptoms are mild. But because of its potential pathogenicity, it can cause a series of cardiovascular and cerebrovascular complications, such as atherosclerosis, hypertension, etc. if not treated in time, it may be easily progressed to abnormal thyroid function and cause metabolic disorder of the body. It has attracted much attention in recent years. Subclinical thyroid dysfunction is a branch of preemptive preventive medicine. It pays attention to subclinical hypothyroidism and will benefit the preprevention of disease. Resistin (Resistin) is a newly discovered adipocyte secreted fat factor, which is involved in metabolic diseases such as atherosclerosis, diabetes, insulin. There is no accurate relationship between resistin and thyroid function, and subclinical thyroid dysfunction or blank. This paper aims to further explore the relationship between subclinical thyroid dysfunction and resistin. Hyperuricemia refers to the blood uric acid caused by purine metabolic disorder or uric acid excretion disorder (Uri The increase of serum uric acid is an independent risk factor for hypertension, atherosclerosis and proteinuria, which is an independent risk factor for cardiovascular disease and an important manifestation of insulin resistance. The study on the correlation of subclinical thyroid dysfunction with uric acid has not been reported at home and abroad. The aim of this paper is to study the study on the relationship between C Acid and urine acid. Homocysteine (HCY) plays a more and more important role in the pathophysiology and prognosis of cardiovascular diseases. It can promote subclinical hypothyroidism and increase the relationship between atherosclerosis and atherosclerosis. The study of changes in clinical hyperthyroidism is not much. The purpose of this paper is to explore the correlation between plasma homocysteine and thyroid function, to provide an objective monitoring index for subclinical hypothyroidism patients. It is particularly important to analyze the complications associated with the complications. This study is to detect the serum levels of Resistin, URIC, and HCY in patients with subclinical thyroid dysfunction and health examination, and to find the use of Resistin, URIC, HCY levels in subclinical thyroid dysfunction, in order to prevent the complications of subclinical hypothyroidism. Objective to provide objective monitoring basis. Methods: 1 subjects randomly selected 70 cases of subclinical thyroid diseases which were initially diagnosed as subclinical thyroid disease without treatment from July 2013 to July 2014, of which 32 cases of subclinical hyperthyroidism were used as subclinical hyperthyroidism, including 12 males and 20 women, with an average age of 34.4 + 13.5 years; subclinical thyroid gland. 38 cases of hypothyroidism as subclinical hypothyroidism and 38 subclinical hypothyroidism, including 16 males and 22 females with an average age of (39.1 + 19.6) years, and 72 healthy persons at the same time as the control group, matched with the age and sex with the patient group. Among them, 30 men and 42 women, with an average age of 36.2 years (36.2 + 15.1) years, were treated with chemiluminescence. The determination of serum free three iodine thyroxine (FT3), free thyroxine (FT4) thyrotropin (TSH), vitamin B12 (Vit B12), folic acid (FA), ELISA method to determine serum resistin (Resistin), determination of serum uric acid (URIC) with end-point rate method and enzyme method for determination of homocysteine (HCY). The subclinical thyroid work of three groups of people was studied by the analysis of serum free thyrotropin (TSH). Changes in serum resistin, uric acid and serum homocysteine (1).2 test method (1) serum FT3, FT4, TSH, Vit B12, FA detection: using chemiluminescence immunoassay, all experiments were carried out in level two biosafety laboratory. (2) serum URIC, HCY, and conventional biochemical indicators CHOL, TG and HDL-C, and other tests: use full automatic biochemistry The instrument was tested in the two level biosafety laboratory. (3) the serum Resistin detection was detected by the enzyme linked immunosorbent sandwich method and was tested in the two level biosafety laboratory according to the operation instructions. The data were processed using the SPSS 16 statistical software. The measurement data were expressed in the mean number of standard deviation, and the 3 groups were compared with the single factor analysis of variance, two The index was linear correlation analysis, and P0.05 was statistically significant. Results: 1 the general data of three groups were compared: the difference of age, sex, BMI, FT3, FT4 in subclinical hyperthyroidism group, subclinical hypothyroidism group and control group was not statistically significant (P 0.05), and 2 subclinical hyperthyroidism group serum CHOL, LDL level was lower than that of control group (P0.05), lower than that of control group (P0.05). In subclinical hypothyroidism group (P0.05), the serum TG and CHOL in subclinical hypothyroidism group were significantly higher than those in the control group, obviously higher than the subclinical hyperthyroidism group, the difference was statistically significant (P0.05). The subclinical hypothyroidism group LDL and the normal control group were not changed but were higher than the subclinical hyperthyroidism group (P0.05), the 3 subclinical hyperthyroidism group was compared with the healthy control group Resistin liters. The difference was statistically significant (P0.05), URIC and HCY were significantly lower than the control group (P0.05), Vit B12, FA was not significantly different from the control group (P0.05). The serum Resistin and FA decreased in the subclinical hypothyroidism group, and the difference was statistically significant (P0.05), while HCY, the difference was statistically significant. Significance (P 0.05).4 subclinical hyperthyroidism group, subclinical hypothyroidism group TSH and Resistin negative correlation, R value is -0.516 (P0.01), -0.411 (P0.05), and subclinical hyperthyroidism group, subclinical hypothyroidism group TSH and HCY are positively correlated, R values are all likely to judge subclinical thyroid function The abnormal diagnosis and curative effect and the development of the disease have a supplementary role in the treatment. It provides objective monitoring basis for preventing the occurrence and development of complications.
【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R581

【引證文獻】

相關期刊論文 前1條

1 宋曉英;辛曉妮;;糖尿病合并促甲狀腺激素及甲狀腺激素異�；颊吲R床診斷治療效果評價[J];中國民康醫(yī)學;2016年13期

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本文編號：2069313