Asvold Bjørn O, Bjøro Trine, Nilsen Tom Ivar L, Gunnell David, Vatten Lars J
Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, N-7489 Trondheim, Norway.
Arch Intern Med. 2008 Apr 28;168(8):855-60. doi: 10.1001/archinte.168.8.855.
Recent studies suggest that relatively low thyroid function within the clinical reference range is positively associated with risk factors for coronary heart disease (CHD), but the association with CHD mortality is not resolved.
In a Norwegian population-based cohort study, we prospectively studied the association between thyrotropin levels and fatal CHD in 17,311 women and 8002 men without known thyroid or cardiovascular disease or diabetes mellitus at baseline.
During median follow-up of 8.3 years, 228 women and 182 men died of CHD. Of these, 192 women and 164 men had thyrotropin levels within the clinical reference range of 0.50 to 3.5 mIU/L. Overall, thyrotropin levels within the reference range were positively associated with CHD mortality (P for trend = .01); the trend was statistically significant in women (P for trend = .005) but not in men. Compared with women in the lower part of the reference range (thyrotropin level, 0.50-1.4 mIU/L), the hazard ratios for coronary death were 1.41 (95% confidence interval [CI], 1.02-1.96) and 1.69 (95% CI, 1.14-2.52) for women in the intermediate (thyrotropin level, 1.5-2.4 mIU/L) and higher (thyrotropin level, 2.5-3.5 mIU/L) categories, respectively.
Thyrotropin levels within the reference range were positively and linearly associated with CHD mortality in women. The results indicate that relatively low but clinically normal thyroid function may increase the risk of fatal CHD.
近期研究表明，临床参考范围内相对较低的甲状腺功能与冠心病（CHD）危险因素呈正相关，但与冠心病死亡率的关联尚未明确。
在一项基于挪威人群的队列研究中，我们前瞻性地研究了17311名女性和8002名男性促甲状腺激素水平与致命性冠心病之间的关联，这些研究对象在基线时无已知甲状腺疾病、心血管疾病或糖尿病。
在中位随访8.3年期间，228名女性和182名男性死于冠心病。其中，192名女性和164名男性的促甲状腺激素水平在0.50至3.5 mIU/L的临床参考范围内。总体而言，参考范围内的促甲状腺激素水平与冠心病死亡率呈正相关（趋势P值 = 0.01）；该趋势在女性中具有统计学意义（趋势P值 = 0.005），但在男性中无统计学意义。与参考范围下限（促甲状腺激素水平，0.50 - 1.4 mIU/L）的女性相比，中间（促甲状腺激素水平，1.5 - 2.4 mIU/L）和较高（促甲状腺激素水平，2.5 - 3.5 mIU/L）类别女性的冠心病死亡风险比分别为1.41（95%置信区间[CI]，1.02 - 1.96）和1.69（95%CI，1.14 - 2.52）。
参考范围内的促甲状腺激素水平与女性冠心病死亡率呈正线性相关。结果表明，相对较低但临床正常的甲状腺功能可能增加致命性冠心病的风险。
