胰岛素抵抗及肥胖对中老年女性甲状腺结节的影响研究

Influence of Insulin Resistance and Obesity on Thyroid Nodules in Middle-aged and Old Women

目的探讨胰岛素抵抗、不同肥胖测量指标对中老年女性甲状腺结节的影响。方法选取2013年3—10月在宁波市镇海区炼化医院体检中心进行健康体检的45岁及以上宁波市某石化企业在职和退休女性员工共1 507例,根据超声检查有无甲状腺结节分为甲状腺结节组（837例）及对照组（670例）。记录受试者年龄、腰围、体质指数（BMI）、收缩压（SBP）、舒张压（DBP）、血脂、甲状腺功能、糖化血红蛋白（Hb A1c）、空腹血糖（FBG）、空腹胰岛素（FINS）水平,并根据FBG和FINS计算胰岛素抵抗指数（HOMA-IR）,评价不同肥胖测量指标与甲状腺结节检出率及HOMA-IR的关系。结果 1 507例女性,检出甲状腺结节837例,检出率为55.5%。甲状腺结节组患者的年龄、腰围、BMI、SBP、DBP、总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、促甲状腺激素（TSH）、Hb A1c、FBG、FINS、HOMA-IR均高于对照组（P〈0.05）。随着BMI的增加甲状腺结节检出率、HOMA-IR均逐渐升高（P〈0.05）。中心性肥胖者甲状腺结节检出率、HOMA-IR均高于非中心性肥胖者（P〈0.05）。随着HOMA-IR的升高,甲状腺结节检出率逐渐升高（χ2趋势=17.257,P〈0.001）。多因素非条件Logistic回归分析显示,年龄〔OR=1.06,95%CI（1.04,1.07）〕、超重〔OR=1.39,95%CI（1.05,1.86）〕、肥胖〔OR=1.83,95%CI（1.07,3.12）〕、TG〔OR=1.18,95%CI（1.00,1.39）〕、TSH〔OR=0.93,95%CI（0.86,1.00）〕、FBG〔OR=1.37,95%CI（1.15,1.64）〕、FINS〔OR=0.94,95%CI（0.89,0.99）〕、HOMA-IR 1.2~1.7〔OR=1.57,95%CI（1.12,2.19）〕、HOMA-IR≥1.8〔OR=1.76,95%CI（1.08,2.83）〕与甲状腺结节检出率有回归关系（P〈0.05）。结论中老年女性甲状腺结节检出率高,与年龄、血脂、甲状腺功能、FBG、FINS关系密切,超重、肥胖、HOMA-IR可能是甲状腺结节发病的危险因素。

Objective To investigate insulin resistance and different obesity measurement indexes on thyroid nodules in middle- aged and old women. Methods Enrolled 1 507 in- service or retired healthy female employees of a petrochemical enterprise in Ningbo who were no younger than 45 years old and received physical examination in the Hospital of Zhenhai Refine-Chemical Company in Ningbo from March to October in 2013. According to the results of ultrasonic examination,the patients were divided into two groups： thyroid nodule group（ n = 837） and control group（ n = 670）. Recorded age,waistline,BMI,SBP,DBP,blood lipid,thyroid function,Hb A1 c,FBG and FINS. We also calculated HOMA- IR according to FBG and FINS,and the relation between different obesity measurement indexes and the prevalence of thyroid nodules and HOMA- IR was evaluated. Results Among 1 507 subjects,837 had thyroid nodules with a prevalence of 55. 5%. Thyroid nodule group was higher（ P〈0. 05） than normal group in age,waistline,BMI,SBP,DBP,TC,TG,LDL- C,TSH,Hb A1 c,FBG,FINS and HOMA- IR. With the increase of BMI, there was an increase（ P〈0. 05） in the prevalence of thyroid nodule and HOMA- IR. Central obesity group was higher（ P〈0. 05） than non- central obesity group in the prevalence of thyroid nodule and HOMA- IR. With the increase of HOMA- IR,there was an increase in the prevalence of thyroid nodule（ χ2trend= 17. 257,P〈0. 001）. The multivariate unconditional Logistic regression analysis showed that age 〔OR = 1. 06,95% CI（ 1. 04,1. 07） 〕,overweight 〔OR = 1. 39,95% CI（ 1. 05,1. 86） 〕, obesity 〔OR = 1. 83,95% CI（ 1. 07,3. 12） 〕, TG 〔OR = 1. 18,95% CI（ 1. 00,1. 39） 〕,TSH 〔OR = 0. 93,95% CI（ 0. 86,1. 00） 〕,FBG 〔OR = 1. 37,95% CI（ 1. 15,1. 64） 〕,FINS〔OR = 0. 94,95% CI（ 0. 89,0. 99） 〕,HOMA- IR 1. 2- 1. 7 〔OR = 1. 57,95% CI（ 1. 12,2. 19） 〕and HOMA- IR≥1. 8 〔OR = 1. 76,95% CI（ 1. 08,2. 83） 〕had regression relation with the prevalence of thyroid nodules. Conclusion The prevalence of thyroid nodule is high among middle- aged and old women and is closely related with age,blood lipid,thyroid function,FBG and FINS. Overweight,obesity,HOMA- IR may be a risk factor for thyroid nodules.