한국인에서 갑상선 호르몬은 관동맥 죽상동맥경화증의 위험인자인가? = Is Thyroid Hormone a Risk Factor of Coronary Atherosclerosis in Korean Patients?

다국어 초록 (Multilingual Abstract)

Background and Objectives ：Overt and subclinical hypothyroidism is known to be associated with developing athe -rosclerosis and adverse changes in blod lipid. There has ben no data regarding the efects of a normal range of thyroid hormone on the presence of coronary atherosclerosis. Subjects and Methods ：We studied 125 consecutive patients (age: 60.0± 11.1 years, male: female=84: 4 1) who underwent diagnostic coronary angiography. The clinical diagnoses on 14.4%). The thyroid hormones [thyroid stimulating hormone (TSH), fre thyroxine and fre 3 -iodothyronine], serum lipid levels, high sensitivity C -reactive protein (hsCRP) level, homocysteine and fibrinogen levels were measured. The coronary angiog -raphic results were compared with laboratory findings. Results：The angiographic diagnoses of coronary artery disea -se were no significant stenosis in 4 1in 37 patients (29.6%). The serum TSH levels showed a trend toward higher levels in the patients with multivessel disease compared to the patients with no significant stenosis ( 1.22± 0.96 uIU/mL vs. 0.73 ± 0.53 uIU/mL, respectively, p=0.053). According to the levels of TSH (< 1.0 uIU/mL and ≥1.0 IU/mL), the incidence of multivessel disease was signi-ficantly higher in the patients with high serum TSH levels (23. 1% vs. 40.0%, respectively, p=0.038). A significant corela -1, p=0.005), hsCRP level (r=0.208, p=0.023) and homocysteine level (r=0.279, p=0.002). Conclusion ：The high level of serum TSH is asociated with multivesel disease, abnormal inflamatory markers and high homocysteine levels.

국문 초록 (Abstract)

배경 및 목적：정상 범위의 갑상선 기능을 보이더라도 갑상선 호르몬의 변화가 관동맥 죽상경화증에 어떤 영향을 미치는지는 아직 알려지지 않았다. 본 연구는 갑상선 질환이 없는 환자들을 대상으로 갑상선 호르몬이 관동맥 죽상경화증의 위험인자가 되는지 알아보고자 하였다.방 법：흉통으로 관동맥 조영술을 시행받기 위해 입원한 125명의 환자(연령 60.0±11.1세, 남자：여자=84：41)를 대상으로 하였다. 대상 환자들의 입원시 임상진단은 안정형 협심증 40명(32.0%), 불안정형 협심증 67명(53.6%), 급성심근경색증이 18명(14.4%) 이었다. TSH, free T4, free T3, 총 콜레스테롤, 중성지방, HDL, LDL 콜레스테롤, Apo A1, Apo B, lipoprotein (a), 단핵구 수, ESR, hsCRP, homocysteine등을 측정하여 관동맥 병변의 정도와 비교하였다. 결 과：관동맥 조영술에서 유의한 협착이 없었던 환자는 41명 (32.8%), 단일혈관질환 47명(37.6%), 두혈관질환 26명 (20.8%), 세혈관질환 11명(8.8%) 이었다. 갑상선 호르몬은 TSH가 다혈관질환일수록 증가하는 경향을 보였으나 통계적인 유의성은 없었다(p=0.056). 혈중 TSH 농도 1.0 uIU/mL 를 기준으로 환자군을 분류했을 때 TSH가 높은 환자들에서 한 혈관 이상 관동맥 질환이 있는 경우가 많았고(57.7% vs.82.2%, p=0.004), 다혈관질환인 경우가 많았다(23.1% vs.40.0%, p=0.038). TSH 농도는 단핵구수(r=0.251, p=0.005), hsCRP(r=0.208, p=0.023), homocysteine(r=0.279, p=0.002)과 유의한 상관관계를 보였다. 관동맥 질환의 존재를 예측하는 독립적인 인자로는 총콜레스테롤, HDL콜레스테롤, Apo A1, Apo B 농도였으며(각각 p=0.034, 0.005, 0.022, 0.025), 갑상선 호르몬의 농도는 예측인자가 되지 못하였다. 결 론：한국인에서 정상 갑상선 기능을 가진 환자라고 하더라도 갑상선 자극 호르몬의 증가는 관동맥 죽상경화증의 중증도를 높일 수 있으며, 이는 혈중 지질 농도 뿐 아니라 염증인자나 homocysteine과도 관련이 있다.

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