绝经女性生殖因素与甲状腺结节的相关性研究

Correlation between reproductive factors and thyroid nodules in postmenopausal women

目的探讨甘肃省兰州市绝经女性生殖因素与甲状腺结节(thyroid nodules,TNs)的相关性,为TNs的防治提供可靠策略。方法选取2014~2016年兰州市天庆嘉园社区、广武门社区和西村街道社区中居住≥5年、≥43岁已绝经女性居民2270名为研究对象,通过问卷调查收集女性的初潮年龄、绝经年龄、孕次、产次、流产次数、妊娠合并症等资料并进行甲状腺超声检查,采用多因素Logistic回归探讨女性生殖因素与TNs的相关性。结果兰州市绝经女性TNs的患病率为60.97%(1384/2270),随着年龄的增加患病率逐渐增加(χ^(2)_(趋势)=66.761,P<0.001)。TNs组中非高等教育比例、患高血压、糖尿病病史比例、吸烟比例更高,TNs组年龄、腰围(WC)、臀围(HC)、收缩压(SBP)、空腹血糖(FBG)、2 h血糖(2hPG)、甘油三酯(HbA1c)、糖化血红蛋白(TG)、血肌酐(Crea)、血尿酸(UA)水平较非TNs组更高,高密度脂蛋白(HDL-C)、血清促甲状腺激素(TSH)、血清游离三碘甲腺原氨酸(FT3)、甲状腺球蛋白抗体(TGAb)、抗甲状腺过氧化物酶抗体(TPOAb)水平较非TNs组更低。随着孕次、产次、绝经年龄的增加,TNs患病率明显升高(孕次:χ^(2)_(趋势)=11.874,P=0.001;产次:χ^(2)_(趋势)=37.385,P<0.001;绝经年龄:χ^(2)_(趋势)=8.897,P=0.003)。纳入多因素Logistic回归结果显示,与绝经年龄<45岁相比,>55岁结节患病风险增加(OR=2.372,95%CI:1.142~4.926,P=0.021),初潮年龄、流产次数、宫外孕、服用避孕药史/雌激素、生育巨大儿、妊娠期合并症、母乳喂养、绝经类型等因素与TNs患病无明显相关性。结论兰州市绝经女性TNs的患病率较高,女性TNs的患病受多种因素影响,其中绝经年龄延迟是女性TNs患病的高危因素,因此应重点加强绝经前女性的甲状腺超声的检查,提早发现TNs的存在以便早期干预。

ObjectiveTo explore the correlation of reproductive factors with thyroid nodules(TNs)in postmenopausal women in Lanzhou,Gansu Province so as to provide reliable strategies for the prevention and treatment of TNs.MethodsA total of 2270 postmenopausal female residents aged 43 and over living in Tianqingjiayuan,Guangwumen and Xicun Street Communities for longer than 5 years in Lanzhou from 2014 to 2016 were recruited as the research objects.The data of menarche age,menopausal age,time of pregnancy,time of delivery,time of abortion and pregnancy complications were surveyed and collected through questionnaires.Thyroid ultrasound examination was performed.Multivariate logistic regression analysis was used to explore the correlation between female reproductive factors and TNs.ResultsThe prevalence of TNs was 60.97%(1384/2270)in postmenopausal women in Lanzhou,and the prevalence was increased gradually with the increase of age(Chi-squaretrend=66.761,P<0.001).The patients in the TNs group had significantly older age,larger proportions of non-higher education level,hypertension,diabetes and smoking,higher levels of WC,HC,SBP,FBG,2hPG,HbA1c,TG,Crea and UA levels,and lower HDL-C,TSH,FT3,TGAb and TPOAb levels when compared with those in the non-TNs group.The prevalence of TNs was increased obviously with the increase of times of pregnancy and childbirth and older menopausal age(time of pregnancies:Chi-squaretrend=11.874,P=0.001;time of delivery:Chi-squaretrend=37.385,P<0.001;menopausal age:Chi-squaretrend=8.897,P=0.003).Multivariate logistic regression analysis showed that the risk of nodules was increased for those with postmenopausal age over 55 years than those with the age<45 years(OR=2.372,95%CI:1.142~4.926,P=0.021).No notable correlation was observed in menarche age,abortion times,ectopic pregnancy,contraceptive/estrogen history,macrosomia,pregnancy complications,breastfeeding,menopausal type and other factors with TNs.Conclusion The prevalence of TNs is quite high in menopausal women in Lanzhou,which is affected by many factors.Among them,the delayed menopausal age is a high-risk factor for the prevalence.Therefore,we should focus on strengthening the thyroid ultrasound examination of perimenopausal women,so as to find the existence early for early intervention.