正常甲状腺功能人群血清促甲状腺激素变化的五年随访研究  

The changes of thyrotropin level in euthyroid population： a 5-year follow-up study in communities with different iodine intakes

作　　者：关海霞[1] 陈彦彦[1] 单忠艳[1] 滕晓春[1] 滕笛[1] 李玉妹[1] 于晓会[1] 范晨玲[1] 崇巍[1] 杨帆[1] 戴红[1] 于扬[1] 李佳[1] 赵冬[1] 毛金媛[1] 滕卫平[1] 

机构地区：[1]中国医科大学附属第一医院内分泌科中国医科大学内分泌研究所,沈阳110001

出　　处：《中华内科杂志》2009年第4期308-311,共4页Chinese Journal of Internal Medicine

基　　金：基金项目：国家自然科学基金（30370680）;辽宁省科技攻关计划（2003225005）

摘　　要：目的探讨正常甲状腺功能者5年随访时促甲状腺激素（TSH）的异常率和影响这一人群TSH发生异常的因素。方法3个不同碘营养背景的农村社区的3403例甲状腺功能正常者中，80．1％（2727例）接受了筛查后的5年随访，测定其m清TSH和甲状腺自身抗体水平。结果随访对象中，68例（2．5％）TSH异常降低（〈0．3mU／L），64例（2．4％）TSH异常增高（〉4．8mU／L）。logistic回归分析显示，初访时甲状腺过氧化物酶抗体（TPOAb）阴性而随访时阳性（OR=5．5）、初访和随访TPOAb均阳性（OR=4．0）、随访时甲状腺球蛋白抗体（TgAb）阳性（OR=3．7）和初访时TSH〈1．0mU／L（OR=2．6）是TSH异常降低的危险因素；而缺碘基础上补碘至碘足量（OR：4．8）、长期碘过量（OR=3．9）、随访时TgAb阳性（OR=3．7）、初访和随访TPOAb均阳性（OR=3．6）、初访时TPOAb阴性而随访时阳性（OR=2．7）和TSH〉1．9mU／L（OR=2．6）是TSH异常增高的危险因素。结论与轻度碘缺乏相比，碘足量和碘过量是TSH由正常转为异常升高的危险因素，缺碘基础上补碘至碘足量导致TSH转为异常升高的危险胜更高于长期碘过量。初访TSH处于1．0—1．9mU／L时，5年随访时发生TSH异常的几率最小。Objective To determine the factors that influence the development of abnormal thyrotropin （TSH） level in an euthyroid population. Methods We conducted a follow-up study in 3 communities with different iodine status. Of the 3403 euthyroid subjects at baseline screened in 1999, 80. 1% （n = 2727 ） was visited and sampled in 2004 for measuring TSH, thyroid peroxidase antibody （TPOAb） and thyroglobulin antibody（TgAb）. Results Iodine status in the 3 communities were stable. Decreased TSH level（ 〈0. 3 mU/L） developed in 2. 5% （n =68） of sampled subjects, while raised TSH level（ 〉 4. 8 mU/L） in 2.4% （n = 64）. A logistic analysis showed that risk factors for developing decreased TSH level included positive conversion of TPOAb （ OR = 5.5 ）, positive TPOAb both in 1999 and in 2004 （OR =4. O）, positive TgAb in 2004 （OR =3.7） and TSH 〈 1.0 mU/L in 1999 （OR =2. 6）. Risk factors involved in developing raised TSH level included iodine status of Zhangwu community （ OR = 4. 1 ） , iodine status of Huanghua community （ OR = 3.9）, positive TgAb in 2004 （ OR = 3.7 ）, positive TPOAb both in 1999 and 2004 （OR =3.6）, positive conversion of TPOAb （OR =2. 7） and TSH 〉 1.9 mU/L in 1999 （ OR = 2. 6 ）. Conclusions Exposure to long-term iodine excess imposes danger of developing hypothyroidism. The risk will be even higher when exposing to iodine adequacy after correction of iodine deficiency. An interval between 1.0 and 1.9 mU/L of TSH level was optimal with the least probability of developing abnormal TSH level.

关 键 词：促甲状腺素 随访研究 碘 

分 类 号：R686[医药卫生—骨科学]