基于心血管事件的促甲状腺激素参考范围上限值研究

TSH Upper Reference Limit and Cardiovascular Events

目的从心血管事件角度,探讨促甲状腺激素(TSH)参考范围上限值。方法本研究为"中国2型糖尿病患者恶性肿瘤发生风险的流行病学研究(REACTION研究)"的附带研究,研究时间为2011年5—8月,研究对象为贵阳市云岩区血清TSH水平在参考范围内的40岁及以上居民7 711例。根据参考范围内的TSH水平,将纳入受试者分为4组:第1组,TSH 0.550~1.499 m U/L,1 297例;第2组,TSH 1.500~2.499 m U/L,2 623例;第3组,TSH2.500~3.499 m U/L,2 188例;第4组,TSH 3.500~4.780 m U/L,1 603例。比较4组受试者的心血管事件患病率,并采用Logistic回归分析探讨参考范围内TSH水平对患心血管事件的影响。结果 4组受试者TSH水平分别为(1.148±0.251)、(2.004±0.284)、(2.977±0.286)、(4.078±0.363)m U/L。4组受试者性别、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)比较,差异有统计学意义(P<0.05);平均年龄、BMI、腰围、收缩压、舒张压、空腹血糖(FPG)、高密度脂蛋白胆固醇(HDL-C)比较,差异无统计学意义(P>0.05)。4组受试者的心血管事件患病率比较,差异无统计学意义(P>0.05)。Logistic回归分析结果显示,参考范围内TSH水平不是患心血管事件的影响因素(P>0.05);分别对性别、年龄和性别、年龄、FPG、TC、TG、LDL-C、HDL-C进行调整后,参考范围内TSH水平仍不是患心血管事件的影响因素(P>0.05)。结论参考范围内不同TSH水平者的心血管事件患病率相似,未发现降低TSH参考范围上限值对降低心血管事件患病率有益的证据。

Objective To investigate the prevalence of cardiovascular events in population with different thyroid stimulating hormone（ TSH） levels and explore the association between TSH upper reference limit and prevalence of cardiovascular events. Methods This was an ancillary study of the ＂ Risk Evaluation of c Ancers in Chinese diabe Tic Individuals： A l ONgitudinal（ REACTION study） ＂. 7 711 residents aged 40 or over and had TSH levels within the reference range in Yunyan District,Guiyang were selected as the subjects from May to August in 2011. Divided them into four groups based on their TSH levels,group 1（ n = 1 297,TSH levels ranged from 0. 550 ~ 1. 499 m U/L）; group 2（ n = 2 623,TSH levels ranged from 1. 500 ~ 2. 499 m U/L）,group 3（ n = 2 188,TSH levels ranged from 2. 500 ~ 3. 499 m U/L） and group 4（ n= 1 603,TSH levels ranged from 3. 500 ~ 4. 780 m U/L）. The prevalence of cardiovascular events was compared in the four groups of subjects. And the association between serum TSH levels within the reference range and prevalence of cardiovascular events was investigated by Logistic regression analysis. Results The average TSH levels of groups 1,2,3 and 4 were（ 1. 148± 0. 251）,（ 2. 004 ± 0. 284）,（ 2. 977 ± 0. 286） and（ 4. 078 ± 0. 363） m U/L,respectively. The four groups had significant differences in male to female ratio, levels of total cholesterol（ TC）, triacylglycerol（ TG） and low-density lipoprotein cholesterol（ LDL-C）（ P 0. 05）,but not in mean age,BMI,waist circumference,systolic blood pressure,diastolic blood pressure,fasting plasma glucose（ FPG） and high-density lipoprotein cholesterol（ HDL-C）（ P 0. 05）. The prevalence of cardiovascular events did not differ significantly between the four groups（ P 0. 05）. Logistic regression analysis showed that the level of TSH in the reference range was not associated with the prevalence of cardiovascular events（ P 0. 05）. After adjusting for sex and age, the level of TSH in the reference range was not associated with the prevalence of cardiovascular events（ P 0. 05）. Furthermore,after adjusting for sex,age,FPG,TC,TG,LDL-C and HDL-C,the level of TSH in the reference range was still not associated with the prevalence of cardiovascular events（ P 0. 05）. Conclusion The prevalences of cardiovascular events for population with different TSH levels within the reference range are similar. Therefore,this cross-sectional study does not provide an evidence in support of lowering the TSH upper reference limit is associated with decreased prevalence of cardiovascular events.