老年男性人群不同维生素D水平与甲状腺功能关系的研究

A Study of the Relationship Between Different Vitamin D Levels and Thyroid Function in Elderly Males

目的研究老年男性25-羟基维生素D水平与甲状腺功能的关系。方法选取2022年4月至7月于我院体检的老年男性,根据25-羟基维生素D水平分为维生素D缺乏组(<20ng/mL)、维生素D不足组(≥20ng/mL至30ng/mL)和维生素D充足组(≥30ng/mL),比较3组人群的一般情况、既往病史、用药情况,以及甲状腺功能、骨代谢等化验指标,采用Pearson相关分析促甲状腺激素的相关指标,多元逐步回归分析促甲状腺激素的影响因素。结果共纳入793例老年男性患者,其中维生素D缺乏组295例(37.2%);维生素D不足组314例(39.6%);维生素D充足组184例(23.2%)。3组人群在一般情况上差异无统计学意义,在年龄方面差异存在统计学意义(P<0.05),表明维生素D受年龄影响较为显著,年龄越大,维生素D越容易缺乏。25-羟基维生素D缺乏组既往病史比例相对更低,化验指标中的甲状旁腺激素、β胶原特殊序列、血钙、红细胞体积分布宽度、血清白蛋白、同型半胱氨酸、尿素、高密度脂蛋白胆固醇、二氧化碳和淀粉酶在3组间差异存在统计学意义(P<0.05,P<0.01)。Pearson相关性分析结果显示,年龄、抗甲状腺过氧化物酶抗体、血清黄体生成激素、血清卵泡刺激素、血清泌乳素、白细胞计数、CYFRA21-1、肌酐、三酰甘油、乳酸脱氢酶、红细胞沉降率、肌钙蛋白T、收缩压等与促甲状腺激素呈正相关,高密度脂蛋白胆固醇、eGFR、尿比重、尿肌酐与促甲状腺激素呈负相关。以促甲状腺素为自变量,以上相关因素为因变量进行多元逐步回归分析。结果显示,血清泌乳素、维生素D、抗甲状腺过氧化物酶抗体、血浆纤维蛋白原、平均血小板体积、淋巴细胞计数、肌酐、尿肌酐是促甲状腺素的影响因素(P<0.05,P<0.01)。其中,维生素D和白细胞计数为负性影响因素。所有指标进入方程的指标的VIF均小于5,没有共线性。25-羟基维生素D、血浆纤维蛋白原、平均血小板体积的容忍度都在85%以上,解释作用为10.2%。结论老年男性血清25-羟基维生素D水平与促甲状腺激素水平成负相关。补充维生素D或许对改善老年人潜在的亚临床甲减状态有益,建议至少将维生素D 3水平维持在20ng/mL以上。

Objective To investigate the relationship between 25-hydroxyvitamin D levels and thyroid function in elderly males.Methods Elderly males who underwent physical examinations in our hospital from April to July,2022 were selected and divided into three groups based on their 25-hydroxyvitamin D levels,including:vitamin D deficiency group(<20ng/mL),vitamin D insufficiency group(≥20ng/mL to<30ng/mL),and vitamin D sufficiency group(≥30ng/mL).General information,past history,medication records,as well as laboratory indicators including thyroid function and bone metabolism of these subjects were collected and compared among the three groups.Pearson correlation analysis were used to explore the relationships between thyroid-stimulating hormone and other indicators.Multiple stepwise regression analysis was applied to identify influencing factors of thyroid-stimulating hormone.Results The study included a total of 793 elderly male patients,among whom 295(37.2%)were deficient in vitamin D,while 314(39.6%)had insufficient levels of vitamin D,and 184(23.2%)had adequate levels of vitamin D.There were no significant differences in general conditions among the three groups,but there was a significant difference in age(P<0.05),indicating that age could significantly affect vitamin D levels,with older age being associated with a higher likelihood of vitamin D deficiency.The group deficient in 25-hydroxyvitamin D had a relatively lower proportion of medical history,and there were significant differences in laboratory indicators such as parathyroid hormone,beta-collagen special sequence,blood calcium,red blood cell volume distribution width,serum albumin,homocysteine,urea,high-density lipoprotein cholesterol,carbon dioxide,and amylase among the three groups(P<0.05,P<0.01).Pearson correlation analysis showed that age,anti-thyroid peroxidase antibody,serum luteinizing hormone,serum follicle-stimulating hormone,serum prolactin,white blood cell count,CYFRA21-1,creatinine,triglycerides,lactate dehydrogenase,erythrocyte sedimentation rate,myoglobin,and systolic blood pressure were positively correlated with thyroid-stimulating hormone,while high-density lipoprotein cholesterol,eGFR,urine specific gravity,and urine creatinine were negatively correlated with thyroid-stimulating hormone.A multiple stepwise regression analysis was performed with thyroid-stimulating hormone as the independent variable and the above correlated factors as the dependent variables.The results showed that serum prolactin,vitamin D grouping,anti-thyroid peroxidase antibody determination,plasma fibrinogen determination,mean platelet volume determination,lymphocyte count,creatinine,and urine creatinine were influencing factors of thyroid-stimulating hormone(P<0.05,P<0.01).Among these identified factors,the vitamin D grouping and white blood cell count were negative influencing factors.VIF of all variables in the equation was less than 5,indicating no collinearity.The tolerance of the 25-hydroxyvitamin D grouping,plasma fibrinogen determination,and mean platelet volume determination were all above 85%,with an explanatory power of 10.2%.Conclusion Serum 25-hydroxyvitamin D levels in elderly males are negatively correlated with thyroid-stimulating hormone levels.Supplementing vitamin D could be beneficial for improving the potential subclinical hypothyroidism in the elderly population.