【作者】 张景；

【导师】 张纯海；

【作者基本信息】 吉林大学 ， 临床医学硕士（专业学位）， 2017， 硕士

【摘要】 目的:对甲状腺癌术后患者进行随访,研究TSH抑制治疗对患者体内血脂水平的作用,同时研究性别、绝经对该作用的影响,并探讨TSH抑制治疗背景下性别、绝经与血脂的关系。方法:通过对2008-2011年于吉林大学中日联谊医院行甲状腺癌根治术的患者进行随访,获得相关临床数据。排除伴有影响血脂的全身系统性疾病者、服用影响血脂药物者、长期烟酒史者及因依从性问题致数据获取不全者,共纳入145例患者的临床数据进行下一步研究。收集患者的相关信息,并测定甲状腺功能、血脂水平,包括血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)。根据TSH抑制程度将患者分为TSH<0.1m IU/L组、0.1m IU/L≤TSH<0.372 m IU/L(TSH正常值下限)组、0.372 m IU/L≤TSH<2.0m IU/L组和TSH≥2.0m IU/L组;根据术后TSH抑制治疗时间将患者分为3年≤时间<5年组和5年≤时间<8年组;同时按照性别差异、是否绝经也分别进行了分类。运用SPSS 19.0软件进行统计学分析,研究TSH抑制治疗的程度和时间对血脂的作用及该作用的性别、绝经差异,并探究TSH抑制治疗背景下性别、绝经和血脂的关系。结果:1.TSH抑制治疗程度与血脂的关系:TSH与总胆固醇、LDL-C呈显著正相关;FT3与总胆固醇、LDL-C呈显著负相关;TSH≥2.0m IU/L组的LDL-C水平显著高于0.372m IU/L≤TSH<2.0m IU/L组;TSH、FT3与甘油三酯、HDL-C、LDL/HDL无显著相关;FT4与血脂谱无显著相关。2.TSH抑制治疗时间与血脂:TSH抑制治疗时间与甘油三酯水平呈显著正相关;5年≤时间<8年组的甘油三酯水平显著高于3年≤时间<5年组;TSH抑制治疗时间与总胆固醇、HDL-C、LDL-C、LDL/HDL无显著相关。3.女性患者TSH抑制治疗的程度与总胆固醇、LDL-C水平存在显著的负相关,TSH抑制治疗的时间与甘油三酯水平存在显著的正相关,以上两种相关性在男性患者群中暂未发现;绝经女性患者TSH抑制治疗的程度与总胆固醇、LDL-C水平存在显著的负相关,TSH抑制治疗的时间与甘油三酯、LDL/HDL水平存在显著的正相关,以上两种相关性在非绝经患者群中并未发现。4.TSH抑制治疗背景下性别、绝经与血脂的关系:男性的甘油三酯、LDL/HDL水平显著高于女性;女性的HDL-C水平显著高于男性;总胆固醇水平、LDL-C水平未见明显性别差异;TSH抑制治疗背景下绝经女性的总胆固醇、甘油三酯、HDL-C、LDL-C、LDL/HDL水平均显著高于非绝经女性。结论:1.甲状腺癌术后TSH抑制治疗利于总胆固醇、LDL-C水平的改善,该作用在TSH值=2m IU/L的节点前后表现更为明显;2.甲状腺癌术后TSH抑制治疗时间对甘油三酯水平存在影响;3.TSH抑制治疗对女性患者血脂水平的影响较男性患者更为明显;TSH抑制治疗对绝经女性患者血脂水平的影响较非绝经女性患者更为明显;4.在TSH抑制治疗背景下,性别、绝经因素对血脂水平存在影响。更多还原

【Abstract】 Objective :To analyze the effect of thyroid-stimulating hormone suppressive therapy on the lipid profile among patients after surgery for thyroid cancer by postoperative follow-up,as well as the role of gender and menopause on that effect.And to explore the effects of gender and menopause on blood lipids under this therapy.Methods:Through the postoperative follow-up among patients who received thyroid surgery therapy in the department of thyroid surgery,China-Japan Union hospital,Jilin University in 2008-2011,clinical data were obtained.All possibilities that may affect blood lipids,for example,systemic diseases,drug-using history,long history of alcohol and tobacco,and bad compliance,were excluded out of this study.At last,Totally 145 patients were enrolled in this study.We collected patients’ information of gender,age,height,weight,related medical history,and tested thyroid function and blood lipids,including serum thyroid stimulating hormone(TSH),three free iodine free triiodothyronine(FT3),free thyroxine(FT4),total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C).According to TSH-inhibited degree patients were divided into four groups which were TSH < 0.1m IU/L group,0.1m IU/L ≤ TSH<0.372 m IU/L(lower limits of normal TSH)group,0.372 m IU/L ≤ TSH < 2.0m IU/L group and TSH ≥ 2.0m IU/L group.Meanwhile patients were divided into two groups according to the time of postoperative TSH suppressive therapy which were 3≤TSH<5 years group and 5≤TSH<8 years group.Patients were also divided by gender and menopausal status separately.SPSS 19.0 software were used for statistical analysis and to analyze the degree and time effect of TSH suppressive therapy on lipid profile and the differences of gender and menopause in that effect.We also explored the gender and menopausal effects on blood lipids under the therapy of TSH suppression.Results:1.The correlation between TSH suppressive therapy and lipid profile: TSH is significantly positively related to TC and LDL-C;FT3 is significantly negatively related to TC and LDL-C;The LDL-C level in TSH≥2.0 m IU/L group is significantly higher than that in 0.372 m IU/L≤TSH<2.0m IU/L group;There is no obvious correlation between TSH、FT3 and TG,HDL-C,or LDL/HDL,so is FT4 and lipid profile.2.The correlation between TSH suppressive therapeutical time and lipid profile: TSH suppressive therapy time and TG are significantly positively related;The level of TG in5≤TSH<8 years group is significantly higher than that in 3≤TSH<5 years group;There is no obvious correlation between treatmeant time and TC,HDL-C,LDL-C or LDL/HDL.3.There exists significant negative correlation in females between the degree of TSH suppressive therapy and total cholesterol,LDL-C,and significant positive correlation between the time of TSH suppressive therapy and triglyceride levels.Those two relations are not observed among males.There exists significant negative correlation in postmenopausal females between the degree of TSH suppressive therapy and total cholesterol,LDL-C,and significant positive correlation between the time of TSH suppressive therapy and triglyceride,LDL/HDL levels.Those two relations above are not observed among non-postmenopausal females.4.The effect of gender and postmenopausal differences on lipid profile during TSH suppressive therapy: Levels of TG and LDL/HDL in males are significantly higher than those in females;HDL-C level has the opposite situation.Levels of TC,TG,HDL-C,LDL-C and LDL/HDL levels in postmenopausal females are significantly higher than those in non-postmenopausal females.Conclusion:1.TSH suppressive therapy after thyroid surgery can improve the levels of TC and LDL-C,which is more obvious around the point of TSH value = 2 m IU/L;2.The time of TSH suppressive therapy after thyroid surgery has an effect on the level of triglyceride;3.The correlation between TSH suppressive therapy and lipid profile in females is more obvious than that in males.The correlation between TSH suppressive therapy and lipid profile in postmenopausal females is more obvious than that in males.4.During TSH suppressive therapy,gender and postmenopause has an effect on lipid profile.更多还原