碘营养适宜体检人群糖化血红蛋白升高对甲状腺结节的影响

The effect of elevated glycosylated hemoglobin on thyroid nodules in population with normal iodine nutrition for physical examination

目的:探讨促甲状腺激素(TSH)水平正常的碘营养适宜体检人群糖化血红蛋白升高对甲状腺结节发生的影响。方法:选取2021年9月—2021年11月5335名参加体检的TSH水平正常人群,按HbA1c升高与否分为HbA1c正常组和HbA1c升高组;按是否有甲状腺结节检出分为无结节组和有结节组,检测收缩压、舒张压、HbA1c、FT4、TSH、体重指数(BMI)、血脂等重要代谢指标并进行比较。结果:甲状腺结节检出2730人,检出率51.17%,HbA1c升高检出786人,检出率14.73%;与HbA1c正常组相比,HbA1c升高组年龄、性别比差异均有统计学意义,高密度脂蛋白-胆固醇(HDL-C)降低,收缩压、舒张压、BMI、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白-胆固醇(LDL-C)、TSH升高(均P<0.05)。与无结节组相比,有结节组尿酸、FT4降低,年龄、HbA1c、收缩压、BMI、TC、TG、LDL-C、HDL-C升高,差异有统计学意义(均P<0.05)。Logistic回归分析显示,HbA1c升高(OR=1.105,95%CI:1.017~1.202,P<0.01)、收缩压(OR=1.017,95%CI:1.011~1.022,P<0.01)及舒张压(OR=0.989,95%CI:0.982~0.997,P<0.01)升高为甲状腺结节发生的危险因素。结论:TSH水平正常的体检人群HbA1c升高、高血压为影响甲状腺结节发生的危险因素。

Objective:To investigate the effect of elevated glycated hemoglobin on thyroid nodules in iodine nutrition suitable population for physical examination with normal thyroid stimulating hormonel(TSH)level.Methods:A total of 5335 people with normal TSH level who participated in physical examination from September 2021 to November 2021 were selected and divided into normal HbA1c group and elevated HbA1c group according to HbA1c level:According to whether thyroid nodules were detected,they were divided into two groups:no nodule group and nodule group.Systolic blood pressure,diastolic blood pressure,HbA1c,FT4,TSH,body mass index(BMI),blood lipids and other important metabolic indicators were measured and compared.Results:A total of 2730 thyroid nodules were detected,with a detection rate of 51.17%.A total of 786 thyroid nodules were detected with elevated HbA1c,with a detection rate of 14.73%.Compared with the normal HbA1c group,the age and gender ratio of the elevated HbA1c group were significantly different.High-density lipoprotein cholesterol(HDL-C)decreased,and systolic blood pressure,diastolic blood pressure,BMI,total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),and TSH increased in the HbA1c elevated group(all P<0.05).Compared with the group without nodules,the group with nodules showed a decrease in uric acid and FT4,while age,HbA1c,systolic blood pressure,diastolic blood pressure,BMI,TC,TG,LDL-C,and HDL-C increased,with statistically significant differences(all P<0.05).Logistic regression analysis showed that elevated HbA1c(OR=1.105,95%CI:1.017-1.202,P<0.01),systolic blood pressure(OR=1.017,95%CI:1.011-1.022,P<0.01),and diastolic blood pressure(OR=0.989,95%CI:0.982-0.997,P<0.01)were independent risk factors for the occurrence of thyroid nodules.Conclusion:Elevated HbA1c and hypertension are risk factors for the occurrence of thyroid nodules in population undergoing physical examination with normal TSH levels.