Specifičan uticaj kardiovaskularnih faktora rizika na koronarnu mikrocirkulaciju u pacijenata sa subkliničkom hipotireozom

Coronary in subclinical hypothyroidism

  • Mirjana Stojković Clinic of endocrinology, diabetes and metabolic disease, University Clinical Center of Serbia
  • Biljana Nedeljković-Beleslin 1. Faculty of Medicine, University od Belgrade 2. Clinic of Endocrinology, Diabetes and Metabolic diseases, Clinical Center of Serbia
  • Milorad Tesic Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia 3. Clinic for Cardiology Clinical Center of Serbia
  • Zoran Bukumiric 1. Faculty of Medicine, University od Belgrade 4. Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade
  • Jasmina Ciric 1. Faculty of Medicine, University od Belgrade 2. Clinic of Endocrinology, Diabetes and Metabolic diseases, Clinical Center of Serbia
  • Milos Stojanovic Stojanovic 1. Faculty of Medicine, University od Belgrade 2. Clinic of Endocrinology, Diabetes and Metabolic diseases, Clinical Center of Serbia
  • Marija Miletic 1. Faculty of Medicine, University od Belgrade 2. Clinic of Endocrinology, Diabetes and Metabolic diseases, Clinical Center of Serbia
  • Ana Djordjevic-Dikic Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia 3. Clinic for Cardiology Clinical Center of Serbia
  • Vojislav Giga Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia 3. Clinic for Cardiology Clinical Center of Serbia0
  • Branko Beleslin Faculty of Medicine, University of Belgrade, Dr Subotica 8, 11000 Belgrade, Serbia 3. Clinic for Cardiology Clinical Center of Serbia
  • Milos Zarkovic 1. Faculty of Medicine, University od Belgrade 2. Clinic of Endocrinology, Diabetes and Metabolic diseases, Clinical Center of Serbia
Ključne reči: kardiovaskularni faktori rizika, koronarna rezerva protoka, subklinička hipotireoza, štitasta žlezda

Sažetak


Uvod: Poznato je da tiroidni hormoni imaju značajan efekat na kardiovaskularni system, ali i dalje ostaje da se utvrdi uticaj suptilnih promena na nivou tiroidne osovine kao što je subklinička hipotireoza (SHT). Ispitivali smo koronarnu rezervu protoka (KRP) kod pacijenata sa subkliničkom hipotireozom.

Metode: Trideset dva ispitanika sa subkliničkom hipotireozom i osamnaest kontrolnih ispitanika sa urednim tiroidnim hormonskim statusom su bili uključeni u studiju. Mereni su TSH, fT4, fT3, glukoza, insulin, HbA1c, holesterol, trigliceridi i CRP. Koronarne dijastolne brzine protoka u levoj prednjoj silaznoj koronarnoj arteriji merene su na početku i nakon infuzije adenozina. Koronarna rezerva protoka je izračunata kao odnos hiperemijske i osnovne dijastolne brzine protoka.

Rezultati: Vrednosti koronarne reserve protoka se nisu značajno razlikovale između dve grupe (SHT 2,76 ± 0,35 u odnosu na kontrole 2,76 ± 0,42). Postojala je značajna korelacija KRP sa odnosom struka i kukova, hipertenzijom, navikama pušenja, markerima glikoregulacije (nivo glukoze, HbA1c, nivo insulina, HOMA IR), holesterolom, LDL-holesterolom i nivoom triglicerida u SHT grupi, dok je samo nivo holesterola pokazao značajnu korelaciju sa KRP u kontrolnoj grupi. Nije bilo korelacije između KRP i hormona štitaste žlezde.

Zaključak: Zaključili smo da postoji drugačiji uticaj kardiovaskularnih faktora rizika na koronarnu rezervu protoka kod pacijenata sa subkliničkom hipotireozom u poređenju sa zdravom kontrolom i da se ove dve grupe ponašaju različito u istim okolnostima, pod istim faktorima rizika. Osnova za ovu razliku mogla bi biti  da promenjen “set point” tiroidne osovine menja osetljivost mikrovaskulature kod pacijenata sa SHT na poznate faktore rizika.

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2021/12/03
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Original paper