血清游离甲状腺素浓度在参考范围内的变化可预测非肥胖成年人代谢综合征的发生率：一项队列研究。

Variations in Serum Free Thyroxine Concentration Within the Reference Range Predicts the Incidence of Metabolic Syndrome in Non-Obese Adults: A Cohort Study.

机构信息

1 Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences , Tehran, I. R. Iran .

2 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences , Tehran, I. R. Iran .

出版信息

Thyroid. 2017 Jul;27(7):886-893. doi: 10.1089/thy.2016.0557.

DOI:10.1089/thy.2016.0557

PMID:28486021

Abstract

BACKGROUND

The association of changes in thyroid hormone values over time with the incidence of metabolic syndrome (MetS) has not yet been evaluated. For the first time, this study assessed the effect of thyroid hormone variations in the subclinical and euthyroid range on the incidence of MetS and its components over a 10-year follow-up in an adult population.

METHODS

Data were analyzed from the prospective population-based Tehran Thyroid Study. Of 5786 randomly selected subjects aged ≥20 years, after excluding subjects with MetS (n = 1403), those with serum thyrotropin (TSH) >10 or <0.1 mIU/L (n = 104), those taking thyroid drugs (n = 85) or corticosteroids (n = 97), those with a body mass index (BMI) <18.5 kg/m, those with a glomerular filtration rate <30, and those with a history of cancer (12), data for 2393 subjects were analyzed. Body weight, waist circumference, and blood pressure were measured, and serum concentrations of lipids and lipoproteins, fasting blood glucose, insulin, free thyroxine (fT4), and TSH were assayed at baseline and during three follow-up studies at three-year intervals. MetS was determined using definition of the Joint Interim Statement, adjusted for the Iranian population.

RESULTS

An increase in fT4 values overtime was associated with lower odds of abdominal obesity (odds ratio [OR] = 0.49 [confidence interval (CI) 0.35-0.69]) and hypertriglyceridemia (OR = 0.57 [CI 0.41-0.78]), and with higher odds of hypertension (OR = 1.35 [CI 1.05-1.74]), adjusted for age, sex, smoking, BMI, and Homeostasis Model Assessment Index for Insulin Resistance. fT4 was associated with lower odds of MetS in the crude model, and after adjustment for age, sex, and smoking (OR = 0.59 [CI 0.39-0.9]). This association lost its significance after further adjusting for BMI. In a subgroup analysis of obese (i.e. BMI ≥30 kg/m) and non-obese (i.e., BMI <30 kg/m) subjects, fT4 was a significant predictor of MetS only in non-obese subjects after adjusting for age, sex, and smoking (β = 0.49 [CI 0.29-0.83], p = 0.007) and also after further adjustment for Homeostasis Model Assessment Index for Insulin Resistance (β = 0.57 [CI 0.34-0.96], p = 0.03). Serum TSH variations over time were not associated with any of the MetS components or with odds of MetS.

CONCLUSION

A decrease in serum fT4 values is associated with an increased risk for MetS, especially in non-obese adults.

摘要

背景

甲状腺激素值随时间变化与代谢综合征（MetS）发生率之间的关联尚未得到评估。本研究首次评估了亚临床和甲状腺功能正常范围内甲状腺激素变化对成年人代谢综合征及其成分的发生率的影响，随访时间为 10 年。

方法

数据来自前瞻性人群基础的德黑兰甲状腺研究。在排除了代谢综合征患者（n=1403）、促甲状腺激素（TSH）>10 或 <0.1mIU/L 患者（n=104）、甲状腺药物或皮质类固醇治疗患者（n=85 和 97）、体重指数（BMI）<18.5kg/m、肾小球滤过率<30 和癌症病史患者（n=12）后，分析了 5786 名年龄≥20 岁的随机选择受试者的数据。在基线和三次随访研究中，每三年测量一次体重、腰围和血压，并检测血脂和脂蛋白、空腹血糖、胰岛素、游离甲状腺素（fT4）和 TSH 的血清浓度。采用联合临时声明的定义确定代谢综合征，并根据伊朗人群进行调整。

结果

fT4 值随时间的增加与腹部肥胖（比值比[OR] = 0.49[95%置信区间（CI）0.35-0.69]）和高甘油三酯血症（OR = 0.57[95%CI 0.41-0.78]）的几率降低有关，与高血压（OR = 1.35[95%CI 1.05-1.74]）的几率增加有关，校正年龄、性别、吸烟、BMI 和胰岛素抵抗评估指数（HOMA-IR）。fT4 在未校正模型中与代谢综合征的几率降低相关，在校正年龄、性别和吸烟后（OR = 0.59[95%CI 0.39-0.9]），该关联失去了意义。在肥胖（即 BMI≥30kg/m）和非肥胖（即 BMI<30kg/m）受试者的亚组分析中，fT4 是代谢综合征的一个显著预测因子，在校正年龄、性别和吸烟后（β=0.49[95%CI 0.29-0.83]，p=0.007），以及进一步校正 HOMA-IR 后（β=0.57[95%CI 0.34-0.96]，p=0.03）。血清 TSH 值随时间的变化与代谢综合征的任何成分或代谢综合征的几率均无关联。