40岁及以上女性人群血清TSH水平与寿命及10年死亡的相关性研究

Serum TSH levels in women aged 40 and above:association with lifespan and 10-year mortality

目的探讨40岁及以上女性促甲状腺素(TSH)水平与10年死亡及寿命的关系。方法对2011年参加"中国2型糖尿病患者肿瘤发生风险的流行病学(REACTION)研究"的贵阳市城区40岁及以上居民进行随访,最终5614人入组,收集基线一般情况,进行体格检查及TSH检测,平均随访(9.77±1.55)年,记录受试者甲状腺相关疾病治疗及死亡情况,采用Cox比例风险模型分析中老年女性TSH水平与10年死亡的关系,并绘制生存时间曲线(K-M曲线)研究<65岁受试者中TSH升高与寿命的关系。结果多因素Cox比例风险模型表明,多变量校正后,TSH升高组与正常组相比,死亡风险降低(HR=0.644,95%CI 0.478~0.868,P<0.05);将TSH升高组分层后,轻度升高组与正常组相比,死亡风险降低(HR=0.566,95%CI 0.405~0.791,P<0.001);进一步将TSH升高组按年龄分组,<65岁组中,轻度升高组与正常组相比,死亡风险降低(HR=0.429,95%CI 0.245~0.751,P=0.003),≥65岁组中,轻度升高组、重度升高组与正常组相比,差异均无统计学意义(P>0.05);<65岁组中,K-M曲线表明TSH轻度升高组的生存率明显高于正常组(χ2=11.931,P=0.003),差异有统计学意义。结论40~65岁女性TSH水平轻度升高与未来10年全因死亡风险降低及寿命较长相关。

Objective To investigate the relationship between thyroid-stimulating hormone(TSH)levels and 10-year mortality in women aged 40 years and older.Methods Residents aged 40 and over in urban areas of Guiyang City who participated in the"Epidemiological Study of Cancer Risk in Patients with Type 2 Diabetes in China(REACTION)"were followed up in 2011.Finally,5614 people were enrolled,and the baseline general information,physical examination and TSH detection were carried out.The average follow-up was(9.77±1.55)years,and the treatment and death of thyroid-related diseases were recorded.The Cox proportional hazards model was used to analyze the relationship between TSH level and 10-year mortality in middle-aged and elderly women,and plotting survival time curves(Kaplan-Meier curves)to study the association between elevated TSH levels and lifespan in subjects under 65 years old.Results The multivariate Cox proportional hazards model showed that compared with the normal group,after multivariate adjustment,the risk of death in the TSH increased group was decreased(HR=0.644,95%CI 0.478-0.868,P<0.05);after stratifying the elevated TSH group,the risk of death was decreased in the slightly elevated TSH group(HR=0.566,95%CI 0.405-0.791,P<0.001);the elevated TSH group was further stratified by age.In the group under 65 years old,compared to the normal group,the mildly elevated group showed a reduced risk of mortality(HR=0.429,95%CI 0.245-0.751,P=0.003).In the group aged 65 and above,there were no statistically significant differences in mortality risk between the mildly elevated group,severely elevated group,and the normal group(P>0.05).In the group under 65 years old,the K-M curve indicated that the survival rate of the mildly elevated TSH group was significantly higher than that of the normal group(χ2=11.931,P=0.003),the difference was statistically significant.Conclusion Mildly elevated TSH levels in women aged 40-65 years are associated with a reduced risk of all-cause death and longer lifespan.