上海地区中老年亚临床甲状腺功能减退与颈动脉内中膜厚度的相关性流行病调查  

Correlation of subclinical hypothyroidism with carotid intima media thickness in Chinese population

作　　者：禤立平 侯亚楠 彭魁[1] 赵志云[1] 李勉[1] 陈宇红[1] 戴蒙[1] 徐敏[1] 毕宇芳[1] 王卫庆[1] 张迪[1] 徐佶佶 XUAN Liping;HOU Yanan;PENG Kui;ZHAO Zhiyun;LI Mian;CHEN Yuhong;DAI Meng;XU Min;BI Yufang;WANG Weiqing;ZHANG Di;XU Jiji(National Clinical Research Center for Metabolic Diseases,Shanghai Institute of Endocrine and Metabolic Diseases,Department of Endocrine and Metabolic Diseases,Ruijin Hospital,Shanghai fiao Tong University School of Medicine,Shanghai 200025,China;General Outpatient Clinic,Community Health Service Center of Songnan Town,Baoshan District,Shanghai 200441,China)

机构地区：[1]国家代谢性疾病临床医学研究中心上海市内分泌代谢病研究所上海交通大学医学院附属瑞金医院内分泌代谢病科,上海200025 [2]上海市宝山区淞南镇社区服务中心全科门诊,上海200441

出　　处：《诊断学理论与实践》2018年第4期444-448,共5页Journal of Diagnostics Concepts & Practice

基　　金：国家自然科学基金(81471062);上海市教育委员会高峰高原学科建设计划(20152508)

摘　　要：目的 :探讨亚临床甲状腺功能减退(subclinical hypothyroidsm,SCH)及促甲状腺激素(thyrotropin,thyroid stimulating hormone,TSH)水平与颈动脉内中膜厚度(carotid intima media thickness,CIMT)之间的相关性。方法 :选取上海市嘉定区6 256名40岁以上甲状腺激素水平正常的居民作为研究对象,采用化学发光酶免疫法测定其甲状腺激素和TSH水平,采用高分辨B型超声检查仪测量CIMT。根据甲状腺功能水平分组,SCH的诊断标准为TSH>4.94μIU/L而FT4在正常范围内,分析SCH、TSH水平与CIMT间的相关性。结果:6 256名研究对象中,SCH患者为458例(7.3%),甲状腺功能正常者(正常组)为5 798例,CIMT增厚者为2 082例(34.6%)。SCH组的CIMT显著增厚[(0.73±0.007)mm比(0.71±0.001)mm,P=0.003]。多元线性回归分析结果显示,Log10-TSH水平与CIMT呈显著正相关(β=0.02,P=0.01),在校正了性别、年龄、体质量指数(body mass index,BMI)、目前是否吸烟、目前是否饮酒、血脂、血压、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、高血压用药情况后,与正常组相比,SCH患者的CIMT增厚风险增加了28%(OR=1.28,95%CI=1.03~1.61,P=0.03)。结论:在上海市嘉定区甲状腺激素水平正常的中老年人群中,SCH患病率为7.3%,CIMT增厚者占34.6%,TSH水平与CIMT增厚呈显著正相关,SCH是CIMT增厚的独立风险因素。Objective： Studies showed that subclinical hypothyroidism（SCH） was associated with an elevated risk of atherosclerotic cardiovascular disease.This community-based cross-section study aimed to investigate the correlation of SCH and thyroid stimulating hormone（TSH） with carotid intima media thickness（CIMT）. Methods： A total of 6 256 Chinese adults（aged≥40 years） with normal thyroid hormone level were enrolled, and standard questionnaire was performed as well as the measurement of anthropometric data and biochemical evaluation. Serum free triiodothyronine（FT3）, free thyroxine（FT4）, and TSH were determined by chemiluminescent immunoassay, while CIMT was measured by a high-resolution B-mode tomographic ultrasound system. Subjects with TSH〉4.94 μIU/L and normal FT4 level were diagnosed as SCH and the others served as controls. Correlations of SCH and TSH level with CIMT were analyzed. Results： There were 458 cases of SCH, 5 798 cases with normal thyroid function, and 2 082 subjects having elevated CIMT. Compared with subjects with normal thyroid function,those with SCH had thicker CIMT [（0.73±0.007） mm vs（0.71±0.001） mm, P=0.003]. Multiple linear regression analysis showed that Log10-TSH was positively correlated with CIMT（β=0.02, P= 0.01）. Adjusted logistic regression analysis revealed that SCH was associated with risk of elevated CIMT [odds ratio（OR）=1.28, 95% confidence interval（CI）=1.03-1.61, P=0.03）]. Conclusions： For middle aged and elderly population with normal thyroid function in Shanghai,prevalence of SCH was 7.3%, and subjects with elevated CIMT account for 34.6%. TSH is positively correlated with CIMT in middle-aged and elderly Chinese subjects, and SCH is the independent risk factor for elevated CIMT.

关 键 词：颈动脉内膜中层厚度 亚临床甲状腺功能减退 促甲状腺激素 

分 类 号：R587.1[医药卫生—内分泌]