Völzke Henry, Robinson Daniel M, Spielhagen Thomas, Nauck Matthias, Obst Anne, Ewert Ralf, Wolff Birger, Wallaschofski Henri, Felix Stephan B, Dörr Marcus
Institut für Community Medicine, Ernst-Moritz-Arndt-Universität, Walther Rathenau Str. 48, D-17487 Greifswald, Germany.
Eur Heart J. 2009 Jan;30(2):217-24. doi: 10.1093/eurheartj/ehn508. Epub 2008 Nov 13.
High serum thyrotropin (TSH) levels within the reference range might be associated with an increased cardiovascular risk. In the present study, we investigated the association between serum TSH levels and flow-mediated dilation (FMD) as a measure of endothelial dysfunction.
The study population comprised 1364 subjects (670 women) aged 25-85 years with serum TSH levels between 0.25 and 2.12 mIU/L recruited from 5-year follow-up of the Study of Health in Pomerania. No interventions were performed. Measurements of FMD and nitrate-mediated dilation (NMD) were performed in the supine position using standardized ultrasound techniques. FMD and NMD values below the median of each distribution were considered decreased. Analyses adjusted for age, sex, smoking, and systolic and diastolic blood pressure revealed a non-significant inverse trend between serum TSH levels and FMD (P = 0.130). Subjects with serum TSH levels above the highest quartile had lower median FMD values relative to subjects with serum TSH levels below the lowest quartile (4.86 vs. 5.43%, P < 0.05). A linear inverse trend between serum TSH levels and decreased FMD barely missed statistical significance (P = 0.138). Subjects with high serum TSH levels had higher odds of decreased FMD relative to subjects with low serum TSH levels (odds ratio 1.42; 95% confidence interval 1.02; 1.96; P < 0.05). These associations were more pronounced in men than in women. There were no such associations for NMD.
Serum TSH levels within the upper reference range are associated with impaired endothelial function. Our findings contribute to the discussion on whether the upper TSH reference limit should be redefined.
参考范围内的高血清促甲状腺激素（TSH）水平可能与心血管风险增加有关。在本研究中，我们调查了血清TSH水平与作为内皮功能障碍指标的血流介导的血管舒张（FMD）之间的关联。
研究人群包括从波美拉尼亚健康研究的5年随访中招募的1364名年龄在25 - 85岁之间、血清TSH水平在0.25至2.12 mIU/L之间的受试者（670名女性）。未进行干预。使用标准化超声技术在仰卧位测量FMD和硝酸酯介导的血管舒张（NMD）。每个分布中位数以下的FMD和NMD值被视为降低。对年龄、性别、吸烟以及收缩压和舒张压进行校正后的分析显示，血清TSH水平与FMD之间存在不显著的负相关趋势（P = 0.130）。血清TSH水平高于最高四分位数的受试者相对于血清TSH水平低于最低四分位数的受试者，其FMD中位数较低（4.86%对5.43%，P < 0.05）。血清TSH水平与FMD降低之间的线性负相关趋势勉强未达到统计学显著性（P = 0.138）。血清TSH水平高的受试者相对于血清TSH水平低的受试者，FMD降低的几率更高（优势比1.42；95%置信区间1.02；1.96；P < 0.05）。这些关联在男性中比在女性中更明显。NMD不存在此类关联。
参考范围上限内的血清TSH水平与内皮功能受损有关。我们的研究结果有助于讨论TSH参考上限是否应重新定义。
