Choi Yun Mi, Kim Won Gu, Kim Tae Yong, Bae Sung Jin, Kim Hong-Kyu, Jang Eun Kyung, Jeon Min Ji, Han Ji Min, Lee Seung Hun, Baek Jung Hwan, Shong Young Kee, Kim Won Bae
1 Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea.
Thyroid. 2014 Apr;24(4):655-61. doi: 10.1089/thy.2013.0460. Epub 2014 Jan 30.
Low serum vitamin D levels have been associated with several autoimmune diseases, but their association with thyroid autoimmunity is unclear. We evaluated the association of serum vitamin D levels with the prevalence of autoimmune thyroid disease (AITD).
Our cross-sectional study included subjects who underwent routine health checkups, which included assays of serum 25-hydroxy vitamin D3 [25(OH)D3] and anti-thyroid peroxidase antibody (TPO-Ab), as well as thyroid ultrasonography (US) between 2008 and 2012 at the Asan Medical Center. We defined AITD according to the levels of TPO-Ab and US findings.
A total of 6685 subjects (58% male; 42% female) were enrolled for this study. Overall prevalence of TPO-Ab positivity and both TPO-Ab/US positivity were 10.1% (6.3% male; 15.3% female) and 5.4% (2.3% male; 9.7% female) respectively. In female subjects, mean serum 25(OH)D3 levels were significantly lower in the TPO-Ab(+) (22.0 vs. 23.5 ng/mL, p=0.030) and TPO-Ab(+)/US(+) groups (21.6 vs. 23.4 ng/mL, p=0.027) compared with the control group, respectively. According to the levels of serum 25(OH)D3, the prevalence of TPO-Ab positivity (21.2%, 15.5%, and 12.6% in deficient, insufficient, and sufficient group, respectively; p=0.001) and both TPO-Ab and US positivity (14.7%, 9.9%, and 7.1% in deficient, insufficient, and sufficient group, respectively; p<0.001) decreased in female subjects. Interestingly, this pattern was significant only in pre-menopausal women (p=0.003 and p<0.001; respectively), but not in postmenopausal women. Multivariate analysis indicated that the adjusted odds ratios (OR) for AITD among those in the 25(OH)D3-deficient [TPO-Ab(+): OR 1.95, p=0.001; TPO-Ab(+)/US(+): OR 2.36, p<0.001] and -insufficient groups [TPO-Ab(+): OR 1.31, p=0.043; TPO-Ab(+)/US(+): OR 1.50, p=0.017] were significantly increased when compared with the sufficient group.
The levels of serum vitamin D were significantly lower in pre-menopausal women with AITD. Vitamin D deficiency and insufficiency were significantly associated with AITD in pre-menopausal women.
低血清维生素D水平与多种自身免疫性疾病相关，但其与甲状腺自身免疫的关系尚不清楚。我们评估了血清维生素D水平与自身免疫性甲状腺疾病（AITD）患病率之间的关联。
我们的横断面研究纳入了2008年至2012年在峨山医学中心接受常规健康检查的受试者，这些检查包括血清25-羟基维生素D3[25(OH)D3]和抗甲状腺过氧化物酶抗体（TPO-Ab）检测，以及甲状腺超声检查（US）。我们根据TPO-Ab水平和超声检查结果定义AITD。
本研究共纳入6685名受试者（58%为男性；42%为女性）。TPO-Ab阳性和TPO-Ab/US均阳性的总体患病率分别为10.1%（男性6.3%；女性15.3%）和5.4%（男性2.3%；女性9.7%）。在女性受试者中，TPO-Ab(+)组（22.0 vs. 23.5 ng/mL，p=0.030）和TPO-Ab(+)/US(+)组（21.6 vs. 23.4 ng/mL，p=0.027）的平均血清25(OH)D3水平分别显著低于对照组。根据血清25(OH)D3水平，女性受试者中TPO-Ab阳性患病率（缺乏、不足和充足组分别为21.2%、15.5%和12.6%；p=0.001）以及TPO-Ab和US均阳性患病率（缺乏、不足和充足组分别为14.7%、9.9%和7.1%；p<0.001）均下降。有趣的是，这种模式仅在绝经前女性中显著（分别为p=0.003和p<0.001），而在绝经后女性中不显著。多变量分析表明，与充足组相比，25(OH)D3缺乏组[TPO-Ab(+)：比值比（OR）1.95，p=0.001；TPO-Ab(+)/US(+)：OR 2.36，p<0.001]和不足组[TPO-Ab(+)：OR 1.31，p=0.043；TPO-Ab(+)/US(+)：OR 1.50，p=0.017]中AITD的调整后OR显著升高。
AITD绝经前女性的血清维生素D水平显著较低。维生素D缺乏和不足与绝经前女性的AITD显著相关。
