Relationship between subclinical hypothyroidism and central arterial pressure related indicators as well as pulse wave velocity in patients with essential hypertension
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摘要: 目的 探讨原发性高血压患者亚临床甲状腺功能减退(亚甲减)与中心动脉压相关指标及臂踝脉搏波传导速度(baPWV)之间的关系。方法 纳入原发性高血压患者451例，根据甲状腺功能(甲功)分成亚甲减组(观察组，120例)和甲功正常组(对照组，331例)。比较2组一般资料、实验室数据、baPWV、外周动脉压及中心动脉压相关指标，采用多元线性逐步回归分析探讨中心动脉压相关指标及baPWV的影响因素，及其与甲功相关指标之间的潜在关系。结果 亚甲减组甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、促甲状腺激素(TSH)、中心动脉收缩压(CSBP)、中心动脉脉压(CPP)、增强压(AP)、校正心率为75次/min的反射波增强指数(AIX75)及baPWV大于对照组(P< 0.05)，亚甲减组游离三碘甲状腺原氨酸(FT3)小于对照组(P< 0.05)。多元线性逐步回归分析显示，亚甲减组血清TSH水平升高是CSBP、CPP、AP、AIX75及baPWV升高的独立危险因素(P< 0.05)。结论 血清TSH水平升高是原发性高血压合并亚甲减患者中心动脉压相关指标及baPWV升高的独立危险因素，亚甲减可以促进原发性高血压患者中心动脉血压的增加及动脉硬化的进展，相对于其他反映甲功的指标，血清TSH水平是评价这种关系敏感且稳定的指标。
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关键词:
- 原发性高血压 /
- 亚临床甲状腺功能减退 /
- 中心动脉压 /
- 脉搏波速度
Abstract: Objective To discuss the relationship between subclinical hypothyroidism and central arterial pressure-related indicators as well as brachial-ankle pulse wave velocity in patients with essential hypertension.Methods A total of 451 patients with essential hypertension were enrolled. According to thyroid function, they were divided into subclinical hypothyroidism group (observation group,n=120) and euthyroidism group(control group,n=331). General data, laboratory data, baPWV, peripheral arterial pressure and central arterial pressure-related indicators were compared. In subclinical hypothyroidism group, multiple linear stepwise regression analysis was used to explore the influencing factors of central arterial pressure-related indicators and baPWV.Results Triglycerides(TG), total cholesterol(TC), low-density lipoprotein cholesterol(LDLC), thyroid-stimulating hormone(TSH), central arterial systolic pressure(CSBP), central arterial pulse pressure (CPP), augmentation index(AP), and AIx corrected for a heart rate of 75 beats/min(AIX75) and baPWV in subclinical hypothyroidism group was greater than that of the control group(P< 0.05). Free triiodothyronine(FT3) in the subclinical hypothyroidism group was smaller than that of the control group(P< 0.05). Multiple linear stepwise regression analysis showed elevated serum TSH levels in subclinical hypothyroidism group were independent risk factors for the increase of CSBP, CPP, AP, AIX75, and baPWV(P< 0.05).Conclusion Elevated serum TSH levels are independent risk factors for the increase of central arterial pressure-related indicators and baPWV in essential hypertension patients with subclinical hypothyroidism. -
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表 1 2组患者临床资料的比较
Table 1. Comparison of clinical data between the two groups
X±S, M(P25, P75) 项目 观察组(120例) 对照组(331例) t/χ2 P 年龄/岁 48.42±10.00 46.45±9.91 1.854 0.064 女性/% 53.33 46.80 1.492 0.222 BMI/(kg·m-2) 25.93±3.81 25.85±3.34 0.217 0.828 FPG/(mmol·L-1) 4.56±0.55 4.47±0.52 1.569 0.117 TG/(mmol·L-1) 1.50(1.07，2.06) 1.35(0.98，1.83) 2.304 0.022 TC/(mmol·L-1) 4.19±0.74 3.90±0.73 3.736 0.000 HDL-C/(mmol·L-1) 1.22±0.27 1.23±0.26 -0.250 0.803 LDL-C/(mmol·L-1) 2.72±0.72 2.56±0.58 2.228 0.027 FT3/(pmol·L-1) 4.83±0.64 4.97±0.62 -2.127 0.034 FT4/(pmol·L-1) 15.58±1.96 15.84±2.04 -1.199 0.231 TT3/(nmol·L-1) 1.71±0.30 1.74±0.27 -1.054 0.292 TT4/(nmol·L-1) 88.93±12.35 89.12±13.50 -0.134 0.893 TSH/(mIU·L-1) 5.45±1.10 2.31±0.86 28.214 0.000 SBP/mmHg1) 140.43±17.17 137.85±14.35 1.473 0.143 DBP/mmHg 84.58±12.82 84.08±10.64 0.380 0.705 PP/mmHg 55.86±11.57 53.77±10.04 1.873 0.062 HR/(次·min-1) 84.83±14.32 85.00±11.32 -0.113 0.910 CSBP/mmHg 125.28±17.28 119.96±12.49 3.092 0.002 CDBP/mmHg 85.68±12.14 84.03±9.29 1.355 0.177 CPP/mmHg 39.65±9.06 35.93±7.51 4.024 0.000 AP 10.11±5.93 8.01±5.03 3.737 0.000 AIX75 22.83±8.92 20.49±10.04 2.257 0.024 baPWV/(cm·s-1) 1515.39±246.42 1461.58±197.98 2.153 0.033 1)1 mmHg=0.133 kPa。 
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表 2 观察组中心动脉压相关指标和baPWV与甲功相关指标的相关性分析
Table 2. Analysis of the correlation between centralarterial pressurerelated indicators as well as baPWV and thyroid functionrelated indicatorsin subclinical hypothyroidism group
项目 FT3 FT4 TT3 TT4 TSH r P r P r P r P r P CSBP -0.081 0.379 0.015 0.873 -0.047 0.607 -0.008 0.928 0.311 0.001 CPP -0.218 0.017 -0.099 0.283 -0.137 0.136 -0.038 0.683 0.280 0.002 AP -0.358 0.000 -0.216 0.018 -0.252 0.006 -0.130 0.157 0.292 0.001 AIX75 -0.301 0.001 -0.270 0.003 -0.167 0.069 -0.101 0.270 0.284 0.002 baPWV -0.149 0.104 0.058 0.532 -0.079 0.393 0.026 0.779 0.215 0.019
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表 3 观察组中心动脉压相关指标和baPWV影响因素的回归分析
Table 3. Regression analysis of the influencing factors of central arterial pressure related indicators and baPWV in subclinical hypothyroidism group
因变量 自变量 Β β t P CSBP TSH 4.876 0.311 3.605 < 0.001 BMI 0.798 0.176 2.036 0.044 CPP TSH 1.942 0.236 2.658 0.009 性别 -3.676 -0.203 -2.286 0.024 AP 性别 -4.278 -0.362 -4.296 < 0.001 TSH 1.148 0.214 2.537 0.012 AIX75 性别 -8.816 -0.495 -6.314 < 0.001 TSH 1.432 0.177 2.259 0.026 baPWV 年龄 10.711 0.435 4.992 < 0.001 FT4 26.997 0.215 2.481 0.015 TSH 38.649 0.173 2.081 0.040
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