合肥市某区人群亚临床甲状腺功能减退症中促甲状腺激素水平与代谢综合征发病的相关性

Correlation between thyroid stimulating hormone level and metabolic syndrome in subclinical hypothyroidism in a district of Hefei City

目的探讨合肥市某区人群亚临床甲状腺功能减退症(SCH)中促甲状腺激素(TSH)水平与代谢综合征(MS)发病的相关性。方法采用整群抽样方法,根据纳入与排除标准,选取合肥市某区2628例年龄大于18岁的常住居民(居住时间≥5年)作为研究对象。根据甲状腺功能将研究对象分为SCH组和甲状腺功能正常组(对照组);根据MS诊断标准,将研究对象分为MS组和非MS组;根据TSH水平三分位数将SCH组分为低位TSH水平、中位TSH水平、高位TSH水平3个亚组。比较不同组间临床参数的差异。应用Logistic回归分析探讨SCH患者中不同TSH水平组间MS的患病风险以及MS患病的独立影响因素。应用受试者工作曲线(ROC)探讨TSH作为SCH中诊断MS的潜在生物标志物的价值。结果调查人群中SCH的检出率为19.29%(507/2628),MS的检出率为29.45%(774/2628)。与对照组比较,SCH组中MS的检出率增高(34.91%vs 27.99%),差异有统计学意义(P=0.002);在SCH组中,随着TSH水平增高,MS检出率逐渐增高(趋势χ=13.717,P=0.001);与对照组比较,在SCH患者中,高位TSH水平组人群中MS的发生风险增加1.722倍(OR=1.722,95%CI 1.702~2.885,P=0.009)。多元logistic回归分析显示TSH是影响MS患病的独立危险因素(OR=1.850,95%CI 1.625~2.002)。ROC分析结果显示TSH的曲线下面积(AUC)为0.811(95%CI 0.696~0.904),TSH的最优截断点为8.76 mIU/L,灵敏度和特异度分别是87.5%和73.9%。结论随着TSH水平增高,合肥市区SCH患者中,MS患病率逐渐增高;TSH为MS发病的独立危险因素,可作为SCH患者MS诊断标志物。

Objective To investigate the correlation between thyroid stimulating hormone(TSH)level and metabolic syndrome(MS)in subclinical hypothyroidism(SCH)in a district in Hefei City.Methods Using the method of cluster sampling survey,according to the inclusion and exclusion criteria,2628 permanent residents aged over 18 years(living time≥5 years)in a district of Hefei City were enrolled.Based on the the thyroid function,subjects were divided into SCH group and normal thyroid function group(control group);According to MS diagnostic criteria,they were divided into MS group and non-MS group;According to the trisection of TSH level,SCH group was divided into three subgroups:low TSH level,medium TSH level and high TSH level.The differences of clinical parameters between different groups were compared.Logistic regression analysis was used to investigate the risk of MS in different TSH levels of SCH patients and the independent influencing factors of MS.Receiver operating curve(ROC)was used to explore TSH as a potential biomarker for the diagnosis of MS in SCH patients.Results The detection rate of SCH was 19.29%(507/2628)and that of MS was 29.45%(774/2628).Compared with the control group,the detection rate of MS in SCH group was significantly higher(34.91%vs 27.99%,P=0.002);In SCH group,the detection rate of MS increased gradually with the increase of TSH level(trendχ~2=13.717,P=0.001).Compared with the control group,the risk of MS in SCH patients with high TSH level increased by 1.722 times(OR=1.722,95%CI 1.702~2.885,P=0.009).Multiple logistic regression analysis found that TSH was an independent risk factor for MS(OR=1.850,95%CI 1.625~2.002).ROC analysis showed that the area under the curve(AUC)of TSH was 0.811(95%CI 0.696~0.904),the optimal cutoff point of TSH was 8.76 mIU/L,and the sensitivity and specificity were 87.5%and 73.9%respectively.Conclusion The prevalence of MS in SCH patients increased gradually with the increase of TSH level in Hefei City.TSH is an independent risk factor for MS,and can be used as a diagnostic marker for MS in SCH patients.