重庆地区甲状腺功能减退症发病情况及其影响因素调查研究
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摘要
背景甲状腺功能减退症可影响患者神经、心血管、内分泌等多系统,近年来我国甲状腺功能减退症发病率呈现逐年上升趋势,但有关重庆地区甲状腺功能减退症发病情况的调查研究少见。目的调查分析重庆地区甲状腺功能减退症发病情况及其影响因素。方法 2017年6—11月,采用多阶段分层整群随机抽样方法抽取重庆市2个城市社区和2个行政村,共2 663人。由培训合格的医生和技师完成本次调查,调查内容包括一般资料[包括性别、年龄、体质指数(BMI)、血压及心率]和代谢指标[包括三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、尿酸(UA)、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、促甲状腺激素(TSH)、抗甲状腺过氧化物酶抗体(TPOAb)、抗甲状腺球蛋白抗体(TgAb)及尿碘浓度(UIC)]。重庆地区甲状腺功能减退症影响因素分析采用多因素Logistic回归分析。结果 (1)183人因资料不全被剔除,最终调查2 480人,甲状腺功能减退症发病率为11.9%(296/2 480),其中亚临床甲状腺功能减退症286例、临床甲状腺功能减退症10例。(2)不同性别、年龄、收缩压(SBP)、TC、LDL、UA、FBG、TPOAb、TgAb及UIC受试者甲状腺功能减退症发病率比较,差异有统计学意义(P<0.05);不同BMI、舒张压(DBP)、心率、TG、HDL、HbA1c受试者甲状腺功能减退症发病率比较,差异无统计学意义(P>0.05)。(3)多因素Logistic回归分析结果显示,性别、年龄、HDL、TgAb是重庆地区甲状腺功能减退症的独立影响因素(P<0.05)。按照年龄进行亚组分析,结果显示,性别、SBP、TPOAb、UIC是重庆地区18～44岁人群甲状腺功能减退症的独立影响因素(P<0.05);性别和HDL是重庆地区45～64岁人群甲状腺功能减退症的独立影响因素(P<0.05);无自变量进入重庆地区≥65岁人群甲状腺功能减退症影响因素的多因素Logistic回归模型。结论重庆地区甲状腺功能减退症发病率较高,主要为亚临床甲状腺功能减退症;性别、年龄、HDL、TgAb是重庆地区甲状腺功能减退症的独立影响因素,且不同年龄段人群甲状腺功能减退症影响因素不同,应有针对性地进行预防。
Background Hypothyroidism may affect the multisystem such as nervous system,cardiovascular system and endocrine system,moreover morbidity of hypothyroidism showed an upward trend year by year in recent years,but survey on prevalence of hypothyroidism in Chongqing is lacking. Objective To investigate the prevalence and influencing factors of hypothyroidism in Chongqing. Methods From June to November 2017,2,663 subjects were selected in 2 urban communities and 2 administrative villages in Chongqing by multi-stage stratified cluster random sampling method. This survey was completed by well-trained doctors and technicians,the survey contents included general information(including gender,age,BMI,blood pressure and heart rate),metabolic markers(including TG,TC,LDL,HDL,UA,FBG,HbA1 c,TSH,TPOAb,TgAb and urine iodine concentration(UIC). Multivariate Logistic regression analysis was used to analyze the influencing factors of hypothyroidism in Chongqing. Results(1)A total of 183 subjects got rid of this survey due to incomplete information,thus 2,480 subjects enrolled eventually,the incidence of hypothyroidism was 11.9%(296/2,480),thereinto 286 subjects were subclinical hypothyroidism,the other 10 subjects were clinical hypothyroidism.(2)There was statistically significant difference of incidence of hypothyroidism in subjects with different gender,age,SBP,TC,LDL,UA,FBG,TPOAb,TgAb and UIC,respectively(P<0.05),while no statistically significant difference of incidence of hypothyroidism was found in subjects with different BMI,DBP,heart rate,TG,HDL or HbA1 c(P>0.05).(3)Multivariate Logistic regression analysis results showed that,gender,age,HDL and TgAb were independent influencing factors of hypothyroidism in Chongqing(P<0.05). Age based subgroup analysis results showed that,gender,SBP,TPOAb and UIC were independent influencing factors of hypothyroidism in subjects aged 18 to 44 years old in Chongqing(P<0.05);gender and HDL were independent influencing factors of hypothyroidism in subjects aged 45 to 64 years old in Chongqing(P<0.05);no independent variable entered into the multivariate Logistic regression model in subjects aged equal or over 65 years old in Chongqing. Conclusion Morbidity of hypothyroidism is relatively high in Chongqing,in which mainly are subclinical hypothyroidism;gender,age,HDL and TgAb are independent influencing factors of hypothyroidism in Chongqing,moreover the influencing factors of hypothyroidism are different in different age groups,which should take targeted prevention.
Background Hypothyroidism may affect the multisystem such as nervous system,cardiovascular system and endocrine system,moreover morbidity of hypothyroidism showed an upward trend year by year in recent years,but survey on prevalence of hypothyroidism in Chongqing is lacking. Objective To investigate the prevalence and influencing factors of hypothyroidism in Chongqing. Methods From June to November 2017,2,663 subjects were selected in 2 urban communities and 2 administrative villages in Chongqing by multi-stage stratified cluster random sampling method. This survey was completed by well-trained doctors and technicians,the survey contents included general information(including gender,age,BMI,blood pressure and heart rate),metabolic markers(including TG,TC,LDL,HDL,UA,FBG,HbA1 c,TSH,TPOAb,TgAb and urine iodine concentration(UIC). Multivariate Logistic regression analysis was used to analyze the influencing factors of hypothyroidism in Chongqing. Results(1)A total of 183 subjects got rid of this survey due to incomplete information,thus 2,480 subjects enrolled eventually,the incidence of hypothyroidism was 11.9%(296/2,480),thereinto 286 subjects were subclinical hypothyroidism,the other 10 subjects were clinical hypothyroidism.(2)There was statistically significant difference of incidence of hypothyroidism in subjects with different gender,age,SBP,TC,LDL,UA,FBG,TPOAb,TgAb and UIC,respectively(P<0.05),while no statistically significant difference of incidence of hypothyroidism was found in subjects with different BMI,DBP,heart rate,TG,HDL or HbA1 c(P>0.05).(3)Multivariate Logistic regression analysis results showed that,gender,age,HDL and TgAb were independent influencing factors of hypothyroidism in Chongqing(P<0.05). Age based subgroup analysis results showed that,gender,SBP,TPOAb and UIC were independent influencing factors of hypothyroidism in subjects aged 18 to 44 years old in Chongqing(P<0.05);gender and HDL were independent influencing factors of hypothyroidism in subjects aged 45 to 64 years old in Chongqing(P<0.05);no independent variable entered into the multivariate Logistic regression model in subjects aged equal or over 65 years old in Chongqing. Conclusion Morbidity of hypothyroidism is relatively high in Chongqing,in which mainly are subclinical hypothyroidism;gender,age,HDL and TgAb are independent influencing factors of hypothyroidism in Chongqing,moreover the influencing factors of hypothyroidism are different in different age groups,which should take targeted prevention.
引文
[1]TAYLORPN,ALBRECHTD,SCHOLZA,etal.Global epidemiology of hyperthyroidism and hypothyroidism[J].Nat Rev Endocrinol,2018,14(5):301-316.DOI:10.1038/nrendo.2018.18.
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[4]SHAN Z,CHEN L,LIAN X,et al.Iodine status and prevalence of thyroid disorders after introduction of mandatory universal salt iodization for 16 years in China:A cross-sectional study in 10 cities[J].Thyroid,2016,26(8):1125-1130.DOI:10.1089/thy.2015.0613.
[5]CANARIS G J,MANOWITZ N R,MAYOR G,et al.The Colorado thyroid disease prevalence study[J].Arch Intern Med,2000,160(4):526-534.DOI:10.1001/archinte.160.4.526.
[6]彭若萱,张红,许琴,等.长春地区女性亚临床甲状腺功能减退症与血脂异常的相关性分析[J].中国妇幼保健,2018,33(23):5328-5330.
[7]胡婉钰,曾志斌,张红.湖南省碘营养状况及碘盐与甲状腺疾病关系的流行病学调查[J].中华实用诊断与治疗杂志,2018,32(8):30-34.DOI:10.13507/j.issn.1674-3474.2018.05.007.
[8]KNUDSEN N,LAURBERG P,RASMUSSEN L B,et al.Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population[J].J Clin Endocrinol Metab,2005,90(7):4019-4024.DOI:10.1210/jc.2004-2225.
[9]IMAIZUMI M,AKAHOSHI M,ICHIMARU S,et al.Risk for ischemic heart disease and all-cause mortality in subclinical hypothyroidism[J].J Clin Endocrinol Metab,2004,89(7):3365-3370.DOI:10.1210/jc.2003-031089.
[10]LAI Y,WANG J,JIANG F,et al.The relationship between serum thyrotropin and components of metabolic syndrome[J].Endoc J,2011,58(1):23-30.DOI:10.1507/endocrj.K10E-272.
[11]CHAKER L,CAPPOLA A R,MOOIJAART S P,et al.Clinical aspects of thyroid function during ageing[J].Lancet Diabetes Endocrinol,2018,6(9):733-742.DOI:10.1016/s2213-8587(18)30028-7.
[12]FEI S,BAO C,DENG M,et al.The prevalence and determinants of hypothyroidism in hospitalized patients with type 2 diabetes mellitus[J].Endocrine,2017,55(1):179-185.DOI:10.1007/s12020-016-1095-2.
[13]HADLOW N C,ROTHACKER K M,WARDROP R,et al.The relationship between TSH and free T4 in a large population is complex and nonlinear and differs by age and sex[J].J Clin Endocrinol Metab,2013,98(7):2936-2943.DOI:10.1210/jc.2012-4223.
[14]SUN X,SHAN Z,TENG W.Effects of Increased Iodine Intake on Thyroid Disorders[J].Endocrinol Metab(Seoul),2014,29(3):240-247.DOI:10.3803/EnM.2014.29.3.240.
[15]GARDU?O-GARCIA JDE J,ALVIRDE-GARCIA U,LóPEZCARRASCO G,et al.TSH and free thyroxine concentrations are associated with differing metabolic markers in euthyroid subjects[J].Eur J Endocrinol,2010,163(2):273-278.DOI:10.1530/EJE-10-0312.
[16]PESIC M M,DANIJELA R,SLOBODAN A,et al.Subclinical hypothyroidism:association with cardiovascular risk factors and components of metabolic syndrome[J].Biotechnology Biotechnological Equipment,2015,29(1):157-163.DOI:10.1080/13102818.2014.991136.
[17]IQBAL A,JORDE R,FIGENSCHAU Y.Serum lipid levels in relation to serum thyroid-stimulating hormone and the effect of thyroxine treatment on serum lipid levels in subjects with subclinical hypothyroidism:the Tromso Study[J].J Intern Med,2006,260(1):53-61.DOI:10.1111/j.1365-2796.2006.01652.x.
[18]YAN Y R,LIU Y,HUANG H,et al.Iodine nutrition and thyroid diseases in Chengdu,China:an epidemiological study[J].QJM,2015,108(5):379-385.DOI:10.1093/qjmed/hcu216.
[19]ZHAI X,ZHANG L,CHEN L,et al.An Age-Specific Serum Thyrotropin Reference Range for the Diagnosis of Thyroid Diseases in Older Adults:A Cross-Sectional Survey in China[J].Thyroid,2018,28(12):1571-1579.DOI:10.1089/thy.2017.0715.
[20]JANKOVIC D,WOLF P,ANDERWALD C H,et al.Prevalence of endocrine disorders in morbidly obese patients and the effects of bariatric surgery on endocrine and metabolic parameters[J].Obes Surg,2012,22(1):62-69.DOI:10.1007/s11695-011-0545-4.
[21]ZIMMERMANN M B,GALETTI V.Iodine intake as a risk factor for thyroid cancer:a comprehensive review of animal and human studies[J].Thyroid Res,2015,8(1):8.DOI:10.1186/s13044-015-0020-8.
[22]金秀兰,陈婷婷,董小婉,等.合肥某区成人尿碘与甲状腺结节流行状况的相关性研究[J].现代预防医学,2018,45(23):4361-4365.
[2]BANO A,DHANA K,CHAKER L,et al.Association of Thyroid Function With Life Expectancy With and Without Cardiovascular Disease:The Rotterdam Study[J].JAMA Intern Med,2017,177(11):1650-1657.DOI:10.1001/jamainternmed.2017.4836.
[3]LEFEVRE M L,U.S.Preventive Services Task Force.Screening for thyroid dysfunction:U.S.Preventive Services Task Force recommendation statement[J].Ann Intern Med,2015,162(9):641-650.DOI:10.7326/M15-0483.
[4]SHAN Z,CHEN L,LIAN X,et al.Iodine status and prevalence of thyroid disorders after introduction of mandatory universal salt iodization for 16 years in China:A cross-sectional study in 10 cities[J].Thyroid,2016,26(8):1125-1130.DOI:10.1089/thy.2015.0613.
[5]CANARIS G J,MANOWITZ N R,MAYOR G,et al.The Colorado thyroid disease prevalence study[J].Arch Intern Med,2000,160(4):526-534.DOI:10.1001/archinte.160.4.526.
[6]彭若萱,张红,许琴,等.长春地区女性亚临床甲状腺功能减退症与血脂异常的相关性分析[J].中国妇幼保健,2018,33(23):5328-5330.
[7]胡婉钰,曾志斌,张红.湖南省碘营养状况及碘盐与甲状腺疾病关系的流行病学调查[J].中华实用诊断与治疗杂志,2018,32(8):30-34.DOI:10.13507/j.issn.1674-3474.2018.05.007.
[8]KNUDSEN N,LAURBERG P,RASMUSSEN L B,et al.Small differences in thyroid function may be important for body mass index and the occurrence of obesity in the population[J].J Clin Endocrinol Metab,2005,90(7):4019-4024.DOI:10.1210/jc.2004-2225.
[9]IMAIZUMI M,AKAHOSHI M,ICHIMARU S,et al.Risk for ischemic heart disease and all-cause mortality in subclinical hypothyroidism[J].J Clin Endocrinol Metab,2004,89(7):3365-3370.DOI:10.1210/jc.2003-031089.
[10]LAI Y,WANG J,JIANG F,et al.The relationship between serum thyrotropin and components of metabolic syndrome[J].Endoc J,2011,58(1):23-30.DOI:10.1507/endocrj.K10E-272.
[11]CHAKER L,CAPPOLA A R,MOOIJAART S P,et al.Clinical aspects of thyroid function during ageing[J].Lancet Diabetes Endocrinol,2018,6(9):733-742.DOI:10.1016/s2213-8587(18)30028-7.
[12]FEI S,BAO C,DENG M,et al.The prevalence and determinants of hypothyroidism in hospitalized patients with type 2 diabetes mellitus[J].Endocrine,2017,55(1):179-185.DOI:10.1007/s12020-016-1095-2.
[13]HADLOW N C,ROTHACKER K M,WARDROP R,et al.The relationship between TSH and free T4 in a large population is complex and nonlinear and differs by age and sex[J].J Clin Endocrinol Metab,2013,98(7):2936-2943.DOI:10.1210/jc.2012-4223.
[14]SUN X,SHAN Z,TENG W.Effects of Increased Iodine Intake on Thyroid Disorders[J].Endocrinol Metab(Seoul),2014,29(3):240-247.DOI:10.3803/EnM.2014.29.3.240.
[15]GARDU?O-GARCIA JDE J,ALVIRDE-GARCIA U,LóPEZCARRASCO G,et al.TSH and free thyroxine concentrations are associated with differing metabolic markers in euthyroid subjects[J].Eur J Endocrinol,2010,163(2):273-278.DOI:10.1530/EJE-10-0312.
[16]PESIC M M,DANIJELA R,SLOBODAN A,et al.Subclinical hypothyroidism:association with cardiovascular risk factors and components of metabolic syndrome[J].Biotechnology Biotechnological Equipment,2015,29(1):157-163.DOI:10.1080/13102818.2014.991136.
[17]IQBAL A,JORDE R,FIGENSCHAU Y.Serum lipid levels in relation to serum thyroid-stimulating hormone and the effect of thyroxine treatment on serum lipid levels in subjects with subclinical hypothyroidism:the Tromso Study[J].J Intern Med,2006,260(1):53-61.DOI:10.1111/j.1365-2796.2006.01652.x.
[18]YAN Y R,LIU Y,HUANG H,et al.Iodine nutrition and thyroid diseases in Chengdu,China:an epidemiological study[J].QJM,2015,108(5):379-385.DOI:10.1093/qjmed/hcu216.
[19]ZHAI X,ZHANG L,CHEN L,et al.An Age-Specific Serum Thyrotropin Reference Range for the Diagnosis of Thyroid Diseases in Older Adults:A Cross-Sectional Survey in China[J].Thyroid,2018,28(12):1571-1579.DOI:10.1089/thy.2017.0715.
[20]JANKOVIC D,WOLF P,ANDERWALD C H,et al.Prevalence of endocrine disorders in morbidly obese patients and the effects of bariatric surgery on endocrine and metabolic parameters[J].Obes Surg,2012,22(1):62-69.DOI:10.1007/s11695-011-0545-4.
[21]ZIMMERMANN M B,GALETTI V.Iodine intake as a risk factor for thyroid cancer:a comprehensive review of animal and human studies[J].Thyroid Res,2015,8(1):8.DOI:10.1186/s13044-015-0020-8.
[22]金秀兰,陈婷婷,董小婉,等.合肥某区成人尿碘与甲状腺结节流行状况的相关性研究[J].现代预防医学,2018,45(23):4361-4365.