The Relationship Between TSH Level And Blood Lipid In Coronary Atheroslerotic Heart Disease Patients With Subclinical Hypothyroidism

Objective: The incidence and mortality of coronary atherosclerotic heart disease(CHD)increase every year as the epidemic spectrum of cardiovascular disease changes.Dyslipidemia is one of the most important risk factors for CHD,which can accelerate the occurrence and progression of atherosclerosis(AS).The change of serum lipid level in CHD patients has important clinical guiding value for its treatment and prognosis.The slight change of thyroid hormone concentration can cause the change of blood lipid level in CHD patients and affect the occurrence of cardiovascular events.Subclinical hypothyroidism(SCH)lacks specific clinical manifestations and is prone to missed diagnosis,resulting in poor therapeutic effect and prognosis in patients with CHD.This study explored the changes of blood lipid levels and the correlation between TSH levels and blood lipids in CHD patients with subclinical hypothyroidism,and provided clinical basis for CHD treatment and prognosis.Methods: Retrospective analysis: from October 2016 to October 2018 due to precardiac discomfort and chest pain in the Baoding First Central Hospital for hospitalization of patients.General clinical data were collected,including past history and personal history.After coronary artery angiography(CAG)examination results confirm for coronary atheroslerotic heart disease(CHD),a total of 235 patients with thyroid function tests,according to the results of the thyroid function tests are divided into subclinical hypothyroidism group(n=135)and normal thyroid function group(n=100),determine the next morning fasting blood lipids and thyroid function level and calculate TC/HDL-C 、 TG/HDL-C 、 LDL-C/HDL-C 、 non-high-density lipoprotein cholesterol(non-HDL-C),atherogenic index of plasma(AIP)and so on blood lipid comprehensive index.To compare the general clinical data,blood lipid and thyroid function levels of the two groups,Spearman was used to analyze the correlation between TSH and blood lipid in subclinical hypothyroidism group.Results: 1 Comparison of general clinical data between subclinical hypothyroidism group and normal thyroid function group: There were no statistically significant differences in gender,age,body mass index(BMI),incidence of hypertension,incidence of stroke,incidence of diabetes,history of smoking and history of drinking between the subclinical hypothyroidism group and the normal thyroid function group(P >0.05).2 Comparison of blood lipid indicators between subclinical hypothyroidism group and normal thyroid function group: 2.1 Comparison of TC、TG、HDL-C、LDL-C、Apo A1、Apo B between subclinical hypothyroidism group and normal thyroid function group: There was no significant difference in HDL-C,Apo A1,Apo B levels between the subclinical hypothyroid group and the normal thyroid function group(P>0.05).The difference between the two groups was statistically significant in terms of TC(P=0.030),TG(P=0.006)and LDL-C(P=0.048)levels(P<0.05).In the subclinical hypothyroidism group,TC,TG and LDL-C were higher than those in the normal thyroid function group.2.2 Comparison of TC/HDL-C、TG/HDL-C、LDL-C/HDL-C、AIP、non-HDL between subclinical hypothyroidism group and normal thyroid function group: There was no significant difference in TG/HDL-C between the subclinical hypothyroid group and the normal thyroid function group(P>0.05).The difference between the two groups was statistically significant in terms of TC/HDL-C(P =0.002),LDL-C/HDL-C(P =0.008),AIP(P =0.020),non-HDL(P=0.007)levels(P<0.05).The subclinical hypothyroidism group had higher TC/HDL-C、LDL-C/HDL-C、AIP and non-HDL than the normal thyroid function group.3 Comparison of thyroid function levels between subclinical hypothyroid group and normal thyroid function group: There was no significant difference in FT3,TT3 and TT4 levels between the subclinical hypothyroidism group and the normal thyroid function group(P >0.05).The difference between the two groups was statistically significant in terms of TSH(P<0.001)and FT4(P=0.011)levels(P<0.05).The subclinical hypothyroid group TSH was higher than the normal thyroid function group and FT4 was lower than that in the normal thyroid function group.4 Correlation between TSH and blood lipid indicators in subclinical hypothyroidism group: Spearman rank correlation analysis showed:In the subclinical hypothyroidism group,TSH level was associated with TC(r=0.369,P< 0.001),TG(r=0.388,P <0.001),LDL-C(r=0.397,P<0.001),TC/HDL-C(r= 0.398,P<0.001),TG/HDL-C(r=0.392,P<0.001),LDL-C/HDL-C(r=0.438,P<0.001),AIP(r=0.395,P<0.001),non-HDL(r=0.394,P<0.001);There was no correlation between TSH level and HDL-C,Apo A1 and Apo B in subclinical hypothyroidism group(P>0.05).Conclusion: Single lipid index combined with comprehensive index of blood lipids can more comprehensively reflect the status of blood lipid metabolism in patients with CHD.This study suggested that there was severe dyslipidemia in patients with coronary heart disease SCH complicated.The TSH level in the SCH group was the highest associated with LDL-C/HDL-C.The comprehensive index of blood lipids could better reflect the dyslipidemia in patients with SCH.It has important clinical guiding value for thyroid function examination in CHD patients with hyperlipidemia.