老年住院患者亚临床甲状腺功能减退与营养状况的关系

Association between subclinical hypothyroidism and nutritional status in elderly inpatients

目的探讨老年住院患者甲状腺功能与营养状况的关系。方法连续纳入符合观察条件的老年住院患者,测定血清TSH、FT3、FT4水平以及血脂和血浆蛋白指标,分析不同TSH水平对血脂和营养指标的影响。结果本组老年患者,亚临床甲状腺减退(subclinical hypothyroidism,SCH)的发生率为4.5%,亚临床甲状腺功能亢进的发生率为2.3%;老年女性血脂、血清TSH水平高于男性。女性SCH组血清TC、Apo B的水平高于甲状腺功能正常组(t=-2.288,P=0.023;t=-1.995,P=0.047);男性SCH组BMI和AC明显低于甲状腺功能正常组(t=2.152,P=0.032;t=2.233,P=0.026)。偏相关分析显示,女性血清TSH水平与血清TC和Alb呈正相关(r=0.097,P=0.045;r=0.118,P=0.015);男性血清TSH水平与BM I和AC呈负相关(r=-0.122,P=0.020;r=-0.122,P=0.020),而与血清TG呈正相关(r=0.107,P=0.043)。老年住院患者SCH与高血压、陈旧性心梗、房颤及冠心病的患病率无相关性(P>0.05)。结论老年住院患者SCH与血脂和蛋白质代谢有关,老年患者SCH不会增加心血管疾病的患病风险。

Objective To investigate the relationship between thyroid hormones and nutritional status in elderly patients.Methods Total 840 patients aged above 60 years admitted in hospital, including 385 males and 455 females were enrolled in the study.Anthropometric indexes, serum FT3, FT4, TSH levels and nutritional biochemical parameters were measured, and the association of TSH levels with lipid profiles and nutritional indices was analyzed.Results In this group of elderly patients, the prevalence of subclinical hypothyroidism （SCH） and subclinical hyperthyroidism was 4.5% and 2.3%, respectively.Lipid profiles, serum TSH level were higher in women than those in men.In women, the levels of serum TC and Apo B were higher in SCH than those in euthyroidism （ t =-2.288, P =0.023; t =-1.995, P =0.047）;while in men, BMI and AC were significantly lower in patients with SCH than those in euthyroidism （ t =2.152, P =0.032; t =2.233, P =0.026）.The partial correlation analysis revealed that serum TSH levels was positively correlated with serum TC and serum Alb in women （ r =0.097, P =0.045; r =0.118, P =0.015）.Serum TSH was negatively correlated with BMI and AC （ r =-0.122, P =0.020; r =-0.122, P =0.020）, and positively correlated with serum TG （ r =0.107, P =0.107） in men.The prevalence of hypertension, prior myocardial infarction, atrial fibrillation and coronary heart disease was not associated with SCH （ P 〉0.05）.Conclusion Subclinical hypothyroidism is associated with hypercholesterolemia and nutritional status in elderly inpatients;however, elderly patients with SCH are unlikely to increase the risk of cardiovascular diseases.