不同性别年龄居民促甲状腺激素水平及其与冠心病发病风险的关联研究  

The level of thyroid stimulating hormones in different gender and age and the association with the risk of coronary heart disease in cohort population

作　　者：刘佳慧 谢涵坤 刘宇[2] 刘敏[2] 吴丹 胡翠宁 徐婷 樊垚 唐伟 沈冲 Liu Jiahui;Xie Hankun;Liu Yu;Liu Min;Wu Dan;Hu Cuining;Xu Ting;Fan Yao;Tang Wei;Shen Chong(Department of Epidemiology,School of Public Health,Nanjing Medical University,Nanjing 211166,China;Center for Disease Control and Prevention of Jurong City,Zhenjiang 212499,China;Department of Endocrinology,Geriatric Hospital of Nanjing Medical University,Nanjing 210024,China;Division of Clinical Epidemiology,Geriatric Hospital of Nanjing Medical University,Nanjing 210024,China)

机构地区：[1]南京医科大学公共卫生学院流行病学系,南京211166 [2]句容市疾病预防控制中心,镇江212499 [3]南京医科大学附属老年医院内分泌科,南京210024 [4]南京医科大学附属老年医院临床流行病研究室,南京210024

出　　处：《中华医学杂志》2024年第46期4197-4203,共7页National Medical Journal of China

基　　金：国家重点研发计划(2018YFC2000703);江苏省重点研发计划社会发展项目(BE2023774)。

摘　　要：目的分析不同性别、年龄居民促甲状腺激素(TSH)水平及其与冠心病发病风险的关联。方法采用多阶段整群随机抽样法于2015年9-12月在江苏省句容市进行基线调查,共10703人纳入分析;计算3种切点值(4.5、7.0、10.0 mU/L)定义下TSH异常升高的比例。随访至2023年8月,收集并核实新发冠心病情况。将TSH水平按年龄和性别进行五分位数分组,采用多因素Cox回归模型分析TSH水平与冠心病发病风险的关系。结果研究对象年龄[M(Q_(1),Q_(3))]为61.1(51.8,67.9)岁,其中男性4168名(38.94%)。在3种切点值定义下,不同性别TSH异常升高比例均随着年龄增长而增加(均P_(趋势)<0.05),且女性中TSH异常升高比例高于男性。排除基线患冠心病者206例,对其余10497名研究对象进行随访。随访(7.33±1.49)年,新发冠心病350例,冠心病累积发病率为3.34%,TSH水平五分位数Q1~Q5组累积发病率分别为3.62%、3.32%、3.56%、3.28%、2.57%。多因素Cox回归模型结果显示,与TSH Q1组相比,Q5组冠心病发病风险最低(HR=0.704,95%CI:0.498~0.994);60岁人群中TSH Q5组与冠心病发病风险降低存在关联(HR=0.484,95%CI:0.243~0.965),且冠心病发病风险随TSH升高呈降低趋势(P_(趋势)=0.008)。结论TSH水平随着年龄增长而升高,且女性高于男性。在60岁人群中,TSH水平较高者冠心病发病风险较低。ObjectiveTo analyze the thyroid stimulating hormone(TSH)levels in different genders and ages,and the association between TSH level and the risk of coronary heart disease.MethodsThe baseline survey was conducted using a multi-stage cluster random sampling method from September to December 2015,in Jurong City,Jiangsu Province.A total of 10703 participants were included in the analysis.The proportion of participants with abnormally elevated TSH defined by three cut-off values(4.5,7.0,and 10.0 mU/L)were calculated.The cohort was followed up until August 2023 to collect and verify new cases of coronary heart disease.The population was divided into age-and gender-specific quintile subgroups based on TSH.Multivariate Cox regression analysis was used to examine the relationship between TSH and the risk of coronary heart disease.ResultsThe median age was[M(Q_(1),Q_(3))]61.1(51.8,67.9)years-old,and there were 4168 males(38.94%)in the study.The proportions of participants with abnormally increased TSH rose with aging in different genders,and was higher in females than in males(all P_(trend)<0.05).A total of 206 participants with coronary heart disease at baseline were excluded,and the other 10497 were followed up for an average of(7.33±1.49)years,during which 350 new cases of coronary heart disease occurred,and the cumulative incidence rate was 3.34%.The cumulative incidence rates among TSH quintile Q_(1)-Q_(5) groups were 3.62%,3.32%,3.56%,3.28%and 2.57%respectively.Multivariate Cox regression analysis indicated that compared with TSH Q1 group,participants in Q5 group had a lowest risk of coronary heart disease(HR=0.704,95%CI:0.498-0.994).The TSH Q5 group was associated with a reduced risk of coronary heart disease in individuals60 years old(HR=0.484,95%CI:0.243-0.965),and the risk of coronary heart disease decreased as TSH levels increased(P_(trend)=0.008).ConclusionsTSH level increases with aging,and is higher in females than in males.In individuals 60 years old,higher levels of TSH may assaciate with a lower incidence

关 键 词：冠心病 促甲状腺激素 关联分析 前瞻性队列研究 

分 类 号：R541.4[医药卫生—心血管疾病]