老年血脂异常患者亚临床性甲状腺功能减退症患病率和影响因素分析

Analysis of the prevalence and influencing factors of subclinical hypothyroidism in elderly patients with dyslipidemia

目的分析老年血脂异常患者亚临床甲状腺功能减退症(SCH)的患病率及影响因素。方法回顾性分析2022年于上海市浦东新区金杨社区卫生服务中心健康体检的老年血脂异常患者。统计SCH的患病率,收集基本资料、生化指标、甲状腺功能及抗体指标,分析老年血脂异常患者SCH的影响因素。结果共纳入897例老年血脂异常患者,SCH患病率为9.14%,女性患病率高于男性(11.19%vs 5.54%,P=0.005)。与非SCH组比较,SCH组女性、甲状腺疾病家族史占比较高,体质量指数(BMI)、收缩压、舒张压(DBP)、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇、空腹血糖、促甲状腺素、甲状腺过氧化物酶抗体(TPOAb)和甲状腺球蛋白抗体(TgAb)水平较高,总甲状腺素和游离甲状腺素水平较低,差异均有统计学意义(P<0.05)。Logistic回归分析显示,BMI、DBP和LDL-C水平升高以及甲状腺疾病家族史是老年血脂异常患者SCH的危险因素。以1.56 IU/mL为诊断SCH的临界值,TPOAb的受试者操作特征(ROC)曲线下面积为0.667,敏感度为76.80%,特异度为49.70%;以2.31 IU/mL为诊断SCH的临界值,TgAb的ROC曲线下面积为0.582,敏感度为51.20%,特异度为76.70%。结论老年血脂异常患者SCH的发病可能与BMI、DBP和LDL-C水平有关,有甲状腺疾病家族史的老年患者更应尽早防治。

Objective To analyze the prevalence and risk factors of subclinical hypothyroidism(SCH)in elderly popu⁃lation with dyslipidemia.Methods The elderly patients with dyslipidemia who underwent physical examination in Health Cen⁃ter of Jinyang Community,Pudong New District in 2022 were retrospectively analyzed.The prevalence of SCH was calculated.Their basic data,biochemical indexes,thyroid function and antibody indexes were collected,and the influencing factors of SCH in these patients were analyzed.Results A total of 897 elderly patients with dyslipidemia were included,with a SCH prevalence rate of 9.14%.The prevalence rate in women was higher than that in men(11.19%vs 5.54%,P=0.005).Com⁃pared with the non⁃SCH group,the proportion of female and family history of thyroid disease were higher in the SCH group,the levels of body mass index(BMI),systolic blood pressure,diastolic blood pressure(DBP),total cholesterol,low density lipoprotein(LDL⁃C),high⁃density lipoprotein,fasting blood glucose,thyroid stimulating hormone,thyroid peroxidase antibody(TPOAb)and thyroglobulin antibody(TgAb)were higher in the SCH group,the levels of total thyroxine and free thyroxine were lower in the SCH group(P<0.05).Logistic regression analysis showed that elevated levels of BMI,DBP,and LDL⁃C,as well as the family history of thyroid disease,were risk factors for SCH in elderly patients with dyslipidemia.Taking 1.56 IU/mL as the critical value for the diagnosis of SCH,the area under receiver operating characteristic(ROC)curve of TPOAb was 0.667,the sensitivity was 76.80%,and the specificity was 49.70%.Taking 2.31 IU/mL as the critical value for the diagno⁃sis of SCH,the area under ROC curve of TgAb was 0.582,the sensitivity was 51.20%,and the specificity was 76.70%.Conclusion The onset of SCH in elderly patients with dyslipidemia may be related to BMI,DBP,and LDL⁃C.Elderly patients with a family history of thyroid diseases should be prevented and treated as soon as possible.