甲亢患者<sup>131</sup>I治疗后血脂、血糖、尿素氮、肌酐变化的临床分析-东南大学学报医学版

甲亢患者¹³¹I治疗后血脂、血糖、尿素氮、肌酐变化的临床分析

单位：1. 东南大学附属中大医院核医学科, 东南大学江苏省分子影像与功能影像重点实验室, 东南大学医学院, 江苏南京 210009;
2. 南京大学医学院附属鼓楼医院核医学科, 江苏南京 210008

分类号：R815.2

出版年·卷·期（页码）：2023·42·第二期（202-209）

摘要：

目的:分析甲亢患者¹³¹I治疗后甲状腺功能及血脂、血糖的变化。方法:选取甲亢患者127例,检测治疗前、治疗后3个月的血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、甘油三酯(TG)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A(APOA)、载脂蛋白B(APOB)、血糖(Glu)、肌酐(Cr)和尿素氮(BUN)水平。根据¹³¹I治疗后3个月的甲状腺激素水平将患者分为4组,分别为甲功减退组64例、甲功正常组27例、甲亢好转组21例、甲亢反弹组15例。根据FT4水平将64例甲功减退患者分为4组,分别是0-1组、3-1组、6-1组、9-1组,比较4组血脂异常比例。结果:¹³¹I治疗后甲功减退组、甲功正常组、甲亢好转组的FT3、FT4显著降低(P<0.01),TSH、TC、HDL-C、LDL-C、APOA、APOB、Cr升高(P<0.05);甲亢反弹组治疗后FT3、FT4升高,Cr降低(P<0.05),血脂无明显变化;甲功减退组、甲功正常组治疗后Glu、BUN下降(P<0.05);当FT4≤6 pmol·L^-1时,高胆固醇血症比例明显增加。结论:¹³¹I治疗后FT3、FT4指标显著改善,Glu、BUN和Cr等指标明显好转;随FT3、FT4下降血脂随之升高,特别是甲减患者,当FT4≤6 pmol·L^-1时,需警惕发生高脂血症。

Objective: To investigate the changes of thyroid function and blood lipids in patients with Graves' hyperthyroidism after ¹³¹I treatment.Methods: Serum thyroid stimulating hormone(TSH), free triiodothyronine(FT3), free thyroxine(FT4), triglyceride(TG), cholesterol(TC), high-density lipoprotein cholesterol(HDL-C), low-density lipoprotein cholesterol(LDL-C),apolipoprotein A(APOA), apolipoprotein B(APOB), glucose(Glu), blood urea nitrogen(BUN),creatinine(Cr)were measured before and 3 months after treatment. According to the thyroid hormone level 3 months after ¹³¹I treatment, the patients were divided into hypothyroid group(64cases), euthyroid group(27cases), hyperthyroidism improved group(21cases)and hyperthyroidism rebounded group(15cases). 64 cases with hypothyroidism were further divided into four groups,0-1 group,3-1 group,6-1 group and 9-1 group, and the proportion of dyslipidemia in each group was compared. Results: After ¹³¹I treatment, FT3 and FT4 were significantly decreased in the hypothyroid, euthyroid and hyperthyroidism improved groups(P<0.01), while TSH, TC, HDL-C, LDL-C, APOA, APOB, and Cr were increased(P<0.05). In the hyperthyroidism rebounded group, FT3 and FT4 increased, Cr decreased after treatment(P<0.05), there was no significant change in blood lipids. Glu and BUN decreased in the hypothyroid and euthyroid groups after treatment(P<0.05).When FT4≤6 pmol·L^-1, the proportion of hypercholesterolemia increased significantly. Conclusion: Significant improvements in FT3, FT4, Glu, BUN and Cr are observed after ¹³¹I treatment,and blood lipids increases with the decrease of FT3, FT4, especially in hypothyroid group, when FT4≤6 pmol·L^-1, should be on guard against hyperlipidaemia.

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