甲状腺结节患病率与糖脂代谢及碘营养状态的相关性研究

Study on the correlation between the prevalence of thyroid nodule and blood glucose,lipid metabolism and iodine nutrient level

目的分析单纯甲状腺结节与血脂血糖代谢及碘营养管理水平的相关性。方法收集上海市金山区2015年7月至12月接受流行病学调查的人群资料进行横断面研究,计算甲状腺结节患病率,并对相关功能指标进行分析。结果603例受试者检出单纯甲状腺结节,患病率为22.6%(603/2669)。其中女性单纯甲状腺结节患者358例,患病率为26.9%,男性单纯甲状腺结节患者245例,患病率为18.3%。女性单纯甲状腺结节患病率高于男性且差异有统计学意义(χ^(2)=27.686,P<0.001)。此外,单纯甲状腺结节患病率随着年龄增长呈现升高趋势[13.1%(92/704)、20.2%(104/514)、25.1%(145/578)、24.4%(107/439)、36.3%(98/270)与34.8%(57/164),χ^(2)=83.872,P<0.001],且在≤30岁组[8.0%(30/704)与18.8%(62/331),χ^(2)=35.716,P<0.001]、>30~≤40岁组[14.1%(37/263)与26.7%(67/251),χ^(2)=12.683,P<0.001]、>60~≤70岁组[26.2%(33/126)与45.1%(65/144),χ^(2)=10.435,P<0.001]、>70岁组[24.4%(21/86)与46.2%(36/78),χ^(2)=8.521,P<0.001]中,男性单纯甲状腺结节患病率低于女性。在单纯甲状腺结节阳性组人群中,空腹血糖[5.12(4.80,5.69)与5.02(4.72,5.48)]、总胆固醇[1.24(0.85,1.86)与1.13(0.77,1.76)]、甘油三酯[4.77(4.09,5.48)与4.49(3.92,5.16)]、低密度脂蛋白胆固醇[2.79(2.26,3.36)与2.63(2.19,3.16)]、高密度脂蛋白胆固醇水平[1.41(1.18,1.66)与1.35(1.13,1.61)]均高于阴性组(U值分别为554818、578468、535622、556067、567960,P均<0.001),甲状腺结节阳性组BMI指数等级分布相对阴性组偏高,且差异有统计学意义[3.7%(77/2066)、50.1%(1034/2066)、32.4%(669/2066)、13.8%(286/2066)与3.2%(19/603)、43.6%(263/603)、38.1%(230/603)、15.1%(91/603),χ^(2)=9.5201,P=0.023]。食用加碘盐的受试者单纯甲状腺结节的患病率显著低于食用非碘盐的受试者[20.7%(436/2102)与29.5%(167/567),χ^(2)=19.376,P<0.001],单纯甲状腺结节阳性组尿碘水平显著低于阴性组[148.4(100.2,213.7)与169.5(115.4,241.75),U=545129.5,P<0.001]。经过Logistic回归筛选后,年龄(OR=1.57,95%CI:1.292~1.908,P<0.001)、性别(OR=1.278,95%CI:1.193~1.368,P<0.001)、体质量指数(body mass index,BMI)等级(OR=1.166,95%CI:1.022~1.330,P=0.022)、总胆固醇(OR=1.105,95%CI:1.005~1.214,P=0.040)、食用加碘盐(OR=0.689,95%CI:0.556~0.854,P=0.001)是甲状腺结节的独立影响因素。结论上海地区单纯甲状腺结节患病率相对较低。年龄、性别、BMI等级、总胆固醇、加碘盐是引发甲状腺结节的独立影响因素,另外血糖水平也可能与甲状腺结节患病率相关。

Objective To analyze the correlation between simple thyroid nodule and blood lipid and glucose metabolism and iodine nutrition level.Methods A cross-sectional study was conducted by collecting data of the population undergoing epidemiological investigation in Jinshan District,Shanghai from July to December 2015,to calculate the prevalence of thyroid nodules and analyze relevant functional indicators.Results Simple thyroid nodules were detected in 603 subjects,with a prevalence of 22.6%(603/2669).There were 358 female patients with simple thyroid nodules,with a prevalence rate of 26.9%,and 245 male patients with simple thyroid nodules,with a prevalence rate of 18.3%.The prevalence of simple thyroid nodule in female was higher than that in male,and the difference was statistically significant(χ^(2)=27.686,P<0.001).In addition,the prevalence of simple thyroid nodules increased with age(13.1%(92/704)and 20.2%(104/514)and 25.1%(145/578)and 24.4%(107/439)and 36.3%(98/270)and 34.8%(57/164),χ^(2)=83.872,P<0.001).In the≤30 years group(8.0%(30/704)vs.18.8%(62/331),χ^(2)=35.716,P<0.001),>30 to≤40 years old group(14.1%(37/263)vs.26.7%(67/251),χ^(2)=12.683,P<0.001),>60 to≤70 years old group(26.2%(33/126)vs.45.1%(65/144),χ^(2)=10.435,P<0.001),and the 70-year-old group(24.4%(21/86)vs.46.2%(36/78),χ^(2)=8.521,P<0.001).The prevalence of simple thyroid nodules in males was lower than that in females.In the simple positive thyroid nodule group,Fasting blood glucose(5.12(4.80,5.69)and 5.02(4.72,5.48)),total cholesterol(1.24(0.85,1.86)and 1.13(0.77,1.76)),triglyceride(4.77(4.09,5.48)and 4.49(3.92,5.16)),low density lipoprotein((2.79(2.26,3.36)and 2.63(2.19,3.16)),and high density lipoprotein cholesterol(1.41(1.18,1.66)and 1.35(1.13,1.61))were higher than those in the negative group(U values were 554818,578468,535622,556067 and 567960,respectively,all P<0.01).The BMI index grade distribution of thyroid nodule positive group was higher than that of negative group,and the difference was statistically significant(3.7%(77/2066),50.1%(1034/2066),32.4%(669/2066),13.8%(286/2066),3.2%(19/603),43.6%(263/603),38.1%(230/603),15.1%(91/603),χ^(2)=9.5201,P=0.023).The prevalence of simple thyroid nodules was significantly lower in the iodized salt group than in the non-iodized salt group(20.7%(436/2102)vs.29.5%(167/567),χ^(2)=19.376,P<0.001).The urinary iodine level in the positive thyroid nodule group was significantly lower than that in the negative group(148.4(100.2,213.7)vs.169.5(115.4,241.75),U=545129.5,P<0.001).After Logistic regression screening,age(OR=1.57,95%CI:1.292-1.908,P<0.001),gender(OR=1.278,95%CI:1.193-1.368,P<0.001),BMI grade(OR=1.166,95%CI:1.022-1.330,P=0.022),total cholesterol(OR=1.105,95%CI:1.005-1.214,P=0.040),iodized salt(OR=0.689,95%CI:0.556-0.854,P=0.001)were independent influencing factors of thyroid nodule.Conclusion The prevalence of simple thyroid nodules in Shanghai is relatively low.Age,sex,BMI level,total cholesterol and iodized salt are independent factors causing thyroid nodules.In addition,blood glucose level may also be related to the prevalence of thyroid nodules.