| This paper mainly includes literature review and clinical cross-sectional study.Review ?:Literature review,a main discusses the influence of subclinical hypothyroidism for cardiovascular disease,subclinical hypothyroidism has the characteristics of low metabolism,and clinical studies have shown that subclinical hypothyroidism can produce higher blood pressure and blood fat,increased carotid intima-media thickness,diabetes,insulin resistance,increase serum homocysteine concentration,promote atherosclerosis plaque inflammation and other negative effects.Timely use of left thyroid hormone replacement therapy can reduce blood pressure,blood lipid,reduce the inflammatory response of atherosclerosis plaque.Many studies have shown that subclinical hypothyroidism can affect the progression of coronary heart disease directly or indirectly from many aspects.It can provide a certain basis for the treatment of patients with coronary heart disease combined with subclinical hypothyroidism.Review ?:The second review mainly summarizes the understanding of Chinese medicine on coronary heart disease and subclinical hypothyroidism.At present,the research status of etiology,pathogenesis,TCM syndromes and treatment of coronary heart disease and subclinical hypothyroidism are also reviewed.The cognition of TCM on coronary heart disease is mainly summarized by the description of Huangdi Neijing similar to coronary heart disease,and the modern research on coronary heart disease is also summarized.Subclinical hypothyroidism is mainly summarized from modern research.Objective:To determine the vascular endothelial function of patients with coronary heart disease by measuring FMD,and to determine the influence of subclinical hypothyroidism on the endothelial function of patients with coronary heart disease and the correlation between the two.The effects of subclinical hypothyroidism on blood lipid and homocysteine were determined by combining the results of thyrotropin and related laboratory biochemical tests.It provides clinical basis for the study of the effect of subclinical hypothyroidism on patients with coronary heart disease.By collecting the four diagnosis results of all test subjects,the TCM syndrome characteristics of subclinical hypothyroidism combined with coronary heart disease were identified,so as to fill the gap of TCM syndrome differentiation research on coronary heart disease combined with subclinical hypothyroidism.Methods:A total of 180 patients were enrolled in our hospital for coronary angiography or coronary CTA.According to the results of coronary angiography and coronary CTA and thyroid function laboratory test results,divided the patients into coronary heart disease with subclinical hypothyroidism group(experimental group),coronary heart disease(CHD)of subclinical hypothyroidism group(control group),coronary heart disease group(blank),for each patient visits in order to understand the general situation,medical history,medication history,etc.?in the second day early in the morning on an empty stomach after admission makes a related index assay of peripheral venous blood and FMD detection was performed before operation?FMD in experimental group and control group were compared to analyze the effect of subclinical hypothyroidism on vascular endothelial function in patients with coronary heart disease.According to the level of thyrotropin(TSH),all subjects were divided into 5 subgroups,and the mean size of FMD between different subgroups was compared to determine whether the vascular endothelial function was affected by TSH.FMD in patients with coronary heart disease(including test group and control group)and non-coronary heart disease group were compared to determine the effect of coronary heart disease on vascular endothelial function.The correlation between Gensini and FMD score,the correlation between age and FMD,the correlation between TSH and FMD,and the correlation between blood lipid and FMD were analyzed.In addition,the influence of subclinical hypothyroidism on TCM syndrome of coronary heart disease was analyzed,and the correlation between subclinical hypothyroidism and TCM syndrome score was discussed.All the data collected in this study were recorded in EXCEL,and SPSS21.0 was used for statistical analysis.Results:1.Compared with the non-subclinical hypothyroidism group of coronary heart disease,the FMD of the subclinical hypothyroidism group of coronary heart disease was lower(P=0.018<0.05).The HCY of CHD combined with subclinical hypothyroidism group was higher than that of non-subclinical hypothyroidism group,and the difference was statistically significant(P=0.000<0.05).There was no significant difference in Gensini score,TG,TC,ldl-c,hdl-c and hs-crp(P>0.05).There was a negative correlation between FMD and Gensini score in the CHD group without subclinical hypothyroidism(r=-0.271,p=0.014<0.05).There was still a negative correlation between FMD and Gensini score in all patients with coronary heart disease(r=-0.252,p=0.002<0.05).There was a negative correlation between FMD and age in the non-subclinical hypothyroidism group(r=-0.252,p=0.023<0.05).Correlation analysis showed that FMD and TSH were negatively correlated in patients with coronary heart disease(r=-0.225,p=0.002<0.05).2.Comparison between the CHD group and the non-chd group:FMD in the CHD group was lower than that in the non-chd group,and the difference was statistically significant(P=0.033<0.05).The Gensini score of the CHD group was higher than that of the non-chd group,and the difference was statistically significant(P=0.000<0.05).Homocysteine(HCY)in the CHD group was lower than that in the non-chd group,and the difference was statistically significant(P=0.007<0.05).Correlation analysis showed that there was a negative correlation between FMD and HCY in the non-chd group(r=-0.423,p=0.022<0.05).FMD in the CHD group was negatively correlated with age,with a significant correlation(r=-0.18,P=0.024).FMD in the non-chd group was negatively correlated with age,with a significant correlation(r=-0.40,P=0.024).3.Subgroup comparison of different TSH levels:The higher TSH was,the lower FMD was(P=0.029<0.05)4.Distribution of TCM syndromes of CHD combined with subclinical hypothyroidism group and non-subclinical CHD:CHD combined with subclinical hypothyroidism group:blood stasis syndrome(47 cases,67.14%)>qi deficiency syndrome(36 cases,51.43%)>Yang deficiency syndrome(31 cases,44.29%)>phlegm-dampness syndrome(15 cases,21.43%);Non-subclinical hypothyroidism of coronary heart disease group:blood stasis syndrome(47 cases,58.02%)>qi stagnation syndrome(39 cases,48.15%)>qi deficiency syndrome(21 cases,25.93%)>phlegm-dampness syndrome(18 cases,22.22%)>Yang deficiency syndrome(14 cases,17.28%).The difference of Yang deficiency syndrome,qi deficiency syndrome and qi stagnation syndrome between the two groups was statistically significant(P<0.05).Conclusion:1.Subclinical hypothyroidism is correlated with vascular endothelial function of coronary heart disease.The higher TSH is,the worse vascular endothelial function is.Age and HCY may aggravate vascular endothelial function injury,and the older and higher HCY are,the more obvious vascular endothelial injury is.FMD was negatively correlated with Gensini score,and the lower the FMD,the higher the degree of coronary artery stenosis.2.Subclinical hypothyroidism has a certain influence on the distribution of TCM syndromes of coronary heart disease,and the yang-deficiency syndrome and qi-deficiency syndrome of patients with coronary heart disease combined with subclinical hypothyroidism are higher than those with simple coronary heart disease. |
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