亚临床甲减患者及正常人群血清促甲状腺激素与血压的相关性研究

A study of the relationship between serum TSH level and blood pressure

目的研究亚临床甲减患者和正常人群血清促甲状腺激素(TSH)与血压的关系。方法采用随机整群抽样方法对2007年沈阳市大东区1319名研究对象进行问卷调查,测量血压、身高、体重,空腹抽血测血清TSH、血糖和胰岛素,TSH异常者进一步测血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)。研究对象分为甲状腺功能正常组和亚临床甲减组,甲状腺功能正常组进一步分为A组(TSH0.3～0.99mIU/L)、B组(TSH1.0～1.9mIU/L)和C组(TSH1.91～4.8mIU/L),分析血清TSH与收缩压、舒张压的关系,比较各组高血压的患病率和患病的危险性。结果不同血清TSH水平与收缩压和舒张压均无关。女性亚临床甲减患者的高血压患病率显著高于甲状腺功能正常者(41.3%对25.6%,P<0.05)。经校正年龄、性别、吸烟状态、胰岛素抵抗指数(HO-MA-IR)和BMI后,亚临床甲减组高血压患病的危险性显著高于甲状腺功能正常组(OR=1.753,95%CI1.067～2.879,P=0.027),这种关系在女性中更显著(OR=3.545,95%CI1.576～7.975,P=0.004),在男性中差异无统计学意义。在血清TSH正常范围内,A组、B组和C组的收缩压和舒张压比较差异均无统计学意义,3组的高血压患病率和高血压患病的危险性也未见区别。结论亚临床甲减可以增加高血压患病的危险性;女性亚临床甲减患者的高血压患病率显著高于甲状腺功能正常者。正常范围内血清TSH的变化对血压没有影响。

Objective To investigate the relationship between different levels of TSH and blood pressure in the subjects with subclinical hypothyroidism and euthyroid. Methods 1319 subjects were carried out a questionnaire survey, blood pressure,height,and body weight measurement. Blood samples were taken in the fasting state to test serum TSH, fasting plasma glucose, and insulin. FT3 and FT4 were further examined if TSH was abnormal. Subjects were divided into euthyroid group and subclinical hypothyroidism group. Euthyroid group was further divided into three groups：group A （TSH 0. 3 -0. 99 mIU/L） ,group B （TSH 1.0 - 1.9 mIU/L） ,and group C （TSH 1.91 -4. 8 mIU/L）. The relationship between different levels of serum TSH and systolic and diastolic blood pressure was analyzed. Results Different levels of serum TSH had no relation with systolic and diastolic blood pressure. The prevalence of hypertension in subclinical hypothyroidism group was significantly higher than euthyroid group in females （41. 3% VS. 25.6% ,P 〈 0.05）. The risk of hypertension in subclinical hypothyroidism group was significantly higher than that in the euthyroid group after adjusted for age, gender, smoking status, HOMA-IR, and BMI （OR = 1. 753,95% CI 1. 067 -2. 879, P = 0. 027 ）. This association was stronger in females （OR = 3. 545,95% CI 1. 576 -7. 975 ,P =0. 004 ） , but there was no statistical significance in males. Within normal range of TSH, Both SBP and DBP were similar among three groups. The prevalence and risk of hypertension were also similar among three groups. Conclusion Subclinical hypothyroidism could increase the risk of hypertension. The prevalence of hypertension in subclinical hypothyroidism group was significantly higher than euthyroid group in females. Change of TSH in normal range did not affect blood pressure.