老年人甲状腺激素水平的增龄性变化

Change of thyroid hormone level with aging in elderly patients

目的探讨老年患者甲状腺激素水平变化规律。方法对我院2011年18月期间做甲状腺功能检查的2433例患者进行登记、分析。按年龄分为成年组，1030例，平均（46．04-10．8）岁；老年组，848例，平均（69．5±6．3）岁；高龄组，555例，平均（83．94-3．8）岁。采用直接化学发光法测定患者血清游离三碘甲状腺原氨酸（FT。）、游离四碘甲状腺原氨酸（FT。）、促甲状腺素（TSH）。结果成年组、老年组、高龄组血清FT3分别为（5．084-2．99）pmol／L、（4．334-1．22）pmol／L、（3．964-0．89）pmol／L，FT4分别为（19．874-10．97）pmol／L、（18．32士5．81）pmol／L、（18．58士6．71）pmol／L，TSH分别为（4．534-14．37）mU／L、（5．51±17．39）mU／I。（3．334-5．65）mU／L；成年组与老年组、高龄组比较，血清FT3（t=7．075、8．799，均P=0．000）、FT。（t=3．732、2．709，均P=0．000）、TSH（P=0．002、0．134）；老年组与高龄组血清FT3（t：6．178，P=0．114）、FT4（t=0．617，P：0．665）、TSH（P=0．180）。老年组、高龄组降低异常检出率FT3（13．3％、25．8％）、FT。（2．9％、1．8％）、TSH（6．8％、12．3％），升高异常检出率FT。（3．1％、0．1％）、FT4（8．6％、9．9％）、TSH（18．0％、15．7％），高龄组FT3、TSH降低发生率明显高于老年组（y。=39．96、15．83，均P=0．000）；而老年组在FTa降低、FT。升高发生率上明显高于高龄组（y。=27．84、16．32，均P0．000）。结论老年人甲状腺激素异常检出率高，对待老年患者要注意做甲状腺功能的测定，及时诊断和治疗老年人甲状腺疾病。

Objective To explore the change rule o{ serum thyroid hormone level in senile patients. Methods Totally 2433 elderly patients in our hospital during Januaryto August 2011 were divided into three groups by age： adult group aged（46.0＋ 10.8）years（n= 1030）, elderly group aged （69.5＋6.3）years （n±848） and advanced age group aged （83.9±3.8）years （n=555）. The levels of serum free triodothyronine （FT3）, free thyroxine （FT4）, thyroid-stimulating hormone （TSH） were determined by chemistry luminescence technique. Results The levels of serum FT3 [ （4.33＋ 1.22） pmol/L, （3. 96±0. 89）pmol/L vs. （5.08＋2.99） pmol/L, t=7.075, 8. 799, both P=0.000] and FT4 %（18.32＋5.81）pmol/L, （18.58±6.71）pmol/L vs. （19.87±10.97） pmol/L, t=3. 732, 2. 709, both P=0. 000]were lower in the elderly and advanced age than in adult. The levels of serum TSH were higher in the elderly than in adult （P=O. 002）, while no difference was found between advanced age and adult （P=0.134）[（5. 51±17. 39） mU/L in the elderly, （3.33±5.65） mU/L in adults vs. （4.53±14.37）mU/L in advanced age 1. There were no significant differences in the levels of serum FTa, FT4 and TSH between advanced age and the elderly （all P〉0.05）. The detection rate of the decreased FTa, FT4 and TSH in elderly and advanced age were （13.3%vs. 25.8%）, （2.9% vs. 1.8%）, （6.8%vs. 12.35）, while the detection rate of increment were （3.1%vs. O. 1%）, （8.6% vs. 9.9%）, （18. O%vs. 15.70%）, respectively. The rates of declined FTa and TSH were obviously higher in the advanced age than in the elderly（X^2= 39.96,15.83, all P= 0. 000）, but the rates of declined FT4 and increased FTa were lower in the advanced age than in the elderly （X^2= 27.84, 16.32,all P=O. 000）. Conclusions The abnormal detection rates of thyroid hormones are high in the elderly, thus due attention should be paid to thyroid function test for early diagnosis and treatment of senile thyroid disease.