目的 探討不同劑量左甲狀腺素治療老年亞臨床甲狀腺功能減退癥的臨床療效及對血壓的影響。方法 以2013年3月-2016年5月于旬陽縣醫(yī)院就診的老年亞臨床甲狀腺功能減退癥患者98例作為研究對象，平均分為A、B兩組各49例，兩組患者均使用左甲狀腺素進行治療。A組患者初始劑量為12.5 μg/d，B組患者初始劑量為25 μg/d，每兩周增加劑量25 μg/d，維持劑量50~150 μg/d治療12周。比較兩組患者臨床療效、甲狀腺功能、血脂水平以及不良反應。結(jié)果 A組患者治愈率與總有效率分別為59.18%與87.76%，B組患者治愈率與總有效率分別為61.22%與91.84%，兩組患者臨床療效差異不顯著。治療后兩組患者甲狀腺功能及血脂水平均優(yōu)于治療前，差異有統(tǒng)計學意義（P<0.05）。治療4周后，B組患者甲狀腺功能及血脂水平優(yōu)于A組，差異有統(tǒng)計學意義（P<0.05）；治療12周后，兩組患者甲狀腺功能及血脂水平差異不顯著。A組總不良反應發(fā)生率為4.08%，明顯低于B組的16.33%，差異有統(tǒng)計學意義（P<0.05）。結(jié)論 不同劑量左甲狀腺素治療老年亞臨床甲狀腺功能減退癥療效相當，大劑量組短期內(nèi)改善甲狀腺功能及血脂效果更好，但低劑量左甲狀腺素不良反應較少，臨床應根據(jù)患者情況采用合適劑量治療。

Objective To investigate the clinical effect of different doses of levothyroxine in treatment of subclinical hypothyroidism and its effect on blood lipid level. Methods 98 cases of subclinical hypothyroidism elderly patients accepted in our hospital from March 2013 to May 2016 were divided into group A and B with 49 patients in each. The two groups were treated with different doses of levothyroxine treatment for 6 months. Then the clinical efficacy, thyroid function, blood lipid levels and adverse reactions of two groups were compared. Results The cure rate and total effective rate of group A were 59.18% and 87.76% respectively. The cure rate and total effective rate of group B were 61.22% and 91.84% respectively. There was no significant differencebetween two groups. After treatment, thethyroid function and blood lipid levels of two groups were better than before treatment. After 4 weeks of treatment, the thyroid function and blood lipid level in group B were better than those in group A (P<0.05). There was no significant difference in thyroid function and blood lipid between the two groups after 12 weeks of treatment. The incidence of total adverse reactions in group A was 4.08%, which was significantly lower than that in group B (16.33%), the difference was statistically significant (P<0.05). Conclusion Different doses of levothyroxine in the treatment ofsubclinical hypothyroidism were similar, and the thyroid function and blood lipids levels were improved after treatment, but the adverse reaction rate of low dose group was less.