生活方式干预期间超重和肥胖儿童促甲状腺激素与心血管疾病风险的关联

Association of TSH With Cardiovascular Disease Risk in Overweight and Obese Children During Lifestyle Intervention.

作者信息

Rijks Jesse M, Plat Jogchum, Dorenbos Elke, Penders Bas, Gerver Willem-Jan M, Vreugdenhil Anita C E

机构信息

Centre for Overweight Adolescent and Children's Healthcare, Department of Pediatrics, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands.

School of Nutrition and Translational Research in Metabolism, Maastricht University, 6229 HR Maastricht, The Netherlands.

出版信息

J Clin Endocrinol Metab. 2017 Jun 1;102(6):2051-2058. doi: 10.1210/jc.2016-3057.

DOI:10.1210/jc.2016-3057

PMID:28379580

Abstract

CONTEXT

Overweight and obese children have an increased risk to develop cardiovascular diseases (CVDs) in which thyroid-stimulating hormone (TSH) has been suggested as an intermediary factor. However, results of cross-sectional studies are inconclusive, and intervention studies investigating changes in TSH concentrations in association with changes in cardiovascular risk parameters in overweight and obese children are scarce.

OBJECTIVE

To gain insight in associations of circulating TSH concentrations and cardiovascular risk parameters in overweight and obese children.

DESIGN

Nonrandomized lifestyle intervention.

SETTING

Centre for Overweight Adolescent and Children's Healthcare.

PATIENTS

Three hundred thirty euthyroid overweight and obese children.

INTERVENTION

Long-term lifestyle intervention.

MAIN OUTCOME MEASURES

TSH concentrations, pituitary TSH release in response to thyrotropin-releasing hormone (TRH), and cardiovascular risk parameters.

RESULTS

At baseline, serum total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triacylglycerol (TAG), and monocyte chemotactic protein 1 concentrations were significantly associated with serum TSH concentrations. TSH release by the pituitary in response to exogenous TRH was not associated with cardiovascular risk parameters. During lifestyle intervention, several cardiovascular risk parameters significantly improved. In children whose body mass index z score improved, changes in TSH concentrations were significantly associated with changes in TC, LDL-C, and TAG concentrations.

CONCLUSIONS

In euthyroid overweight and obese children, circulating TSH concentrations are positively associated with markers representing increased CVD risk. Changes in TSH concentrations are also associated with changes in lipid concentrations in children with successful weight loss, which is consistent with TSH being an intermediary factor in modulating lipid and lipoprotein metabolism.

摘要

背景

超重和肥胖儿童患心血管疾病（CVD）的风险增加，其中促甲状腺激素（TSH）被认为是一个中介因素。然而，横断面研究的结果尚无定论，且针对超重和肥胖儿童TSH浓度变化与心血管风险参数变化之间关系的干预研究较少。

目的

了解超重和肥胖儿童循环TSH浓度与心血管风险参数之间的关系。

设计

非随机生活方式干预。

地点

超重青少年和儿童医疗保健中心。

患者

330例甲状腺功能正常的超重和肥胖儿童。

干预

长期生活方式干预。

主要观察指标

TSH浓度、垂体对促甲状腺激素释放激素（TRH）的反应性TSH释放以及心血管风险参数。

结果

在基线时，血清总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、三酰甘油（TAG）和单核细胞趋化蛋白1浓度与血清TSH浓度显著相关。垂体对外源性TRH的反应性TSH释放与心血管风险参数无关。在生活方式干预期间，多个心血管风险参数显著改善。在体重指数z评分改善的儿童中，TSH浓度变化与TC、LDL-C和TAG浓度变化显著相关。