甲状腺功能正常人群甲状腺激素敏感性与骨质疏松关系研究

Impaired sensitivity to thyroid hormones is associated with osteoporosis in euthyroid population

目的探讨甲状腺功能正常人群的甲状腺功能及甲状腺激素敏感性指数与骨质疏松风险的关系。方法该研究为横断面研究。纳入2010年1月至2013年12月参加南京市鼓楼区流行病调查研究甲状腺功能正常且基线数据完整的2116名研究对象。探讨甲状腺功能、甲状腺反馈分位数指数(TFQI)、参数化甲状腺反馈分位数指数(PTFQI)、促甲状腺激素细胞-T4抵抗指数(TT4RI)和游离三碘甲状腺原氨酸/游离甲状腺素比值(FT3/FT4)与骨质疏松的相关性。结果与非骨质疏松组相比,骨质疏松组性别构成、丙氨酸氨基转移酶(ALT)、促甲状腺素(TSH)、TFQI、PTFQI、TT4RI、空腹血糖(FPG)、HbA1C差异均有显著统计学意义。Spearman相关性分析提示骨质疏松与年龄(r=0.142,P<0.001)呈正相关,与TSH(r=-0.134,P<0.001)、TFQI(r=-0.102,P<0.001)、PTFQI(r=-0.100,P<0.001)、TT4RI(r=-0.126,P<0.001)呈负相关。校正混杂因素后,Logistic回归显示骨质疏松风险与TSH(OR=0.890,95%CI 0.830~0.954)、TFQI(OR=0.744,95%CI 0.604~0.916)、PTFQI(OR=0.769,95%CI 0.623~0.949)、TT4RI(OR=0.993,95%CI 0.989~0.997)水平呈负相关。限制性立方样条图、logistic回归模型发现TSH(B=-0.025,P=0.001)、TFQI(B=-0.015,P=0.049)、PTFQI(B=-0.016,P=0.035)、TT4RI(B=-0.026,P=0.001)与骨质疏松呈倒"U"型关系。结论甲状腺功能正常的人群中,TSH及甲状腺激素中枢敏感性指数与骨质疏松风险呈倒"U"型相关。

Objective To evaluate the association of thyroid function and thyroid hormone sensitivity index with the risk of osteoporosis in euthyroid population.Methods In this cross-sectional study,2116 euthyroid subjects with complete baseline data from the epidemiological survey conducted in the Gulou District,Nanjing City,from January 2010 to December 2013 were enrolled.The study delved into the correlation between osteoporosis and various indices,including thyroid function,thyroid feedback quantile index(TFQI),parameterized thyroid feedback quantile index(PTFQI),thyroid-stimulating hormone cell-T4 resistance index(TT4RI),and the ratio of free triiodothyronine to free thyroxine(FT3/FT4).Results Compared to the non-osteoporosis group,the osteoporosis group exhibited significant differences in gender composition,alanine transaminase(ALT),thyroid stimulating hormore(TSH),TFQI,PTFQI,TT4RI,fasting plasma glucose(FPG),and HbA1C.Spearman correlation analysis demonstrated a positive correlation of osteoporosis with age(r=0.142,P<0.001),and a negative correlation with TSH(r=-0.134,P<0.001),TFQI(r=-0.102,P<0.001),PTFQI(r=-0.100,P<0.001),and TT4RI(r=-0.126,P<0.001).Meanwhile,Logistic regression analysis adjusting for confounding factors,revealed a negative association between the risk of osteoporosis and TSH(OR=0.890,95%CI 0.830-0.954),TFQI(OR=0.744,95%CI 0.604-0.916),PTFQI(OR=0.769,95%CI 0.623-0.949),and TT4RI(OR=0.993,95%CI 0.989-0.997).Noteworthy,restricted cubic spline and logistic regression models unveil an inverted U-shaped relationship of TSH(B=-0.025,P=0.001),TFQI(B=-0.015,P=0.049),PTFQI(B=-0.016,P=0.035),and TT4RI(B=-0.026,P=0.001)with osteoporosis.Conclusion Osteoporosis has an inverted U-shaped association of TSH with thyroid central sensitivity indices(TFQI,PTFQI and TT4RI)in the euthyroid population.