亚临床甲状腺疾病和甲状腺功能正常者的代谢脆弱性指数（MVX）：来自巴西成人健康纵向研究（ELSA-Brasil）的横断面探索性分析
The Metabolic Vulnerability Index (MVX) in Subclinical Thyroid Disorders and Euthyroidism: A Cross-Sectional Exploratory Analysis from the ELSA-Brasil Study.
作者信息
Janovsky Carolina Castro Porto Silva, Meneghini Vandrize, Tebar William, Martins Joao Roberto Maciel, Sgarbi José Augusto, Teixeira Patrícia de Fatima Dos Santos, Santos Itamar de Souza, Jones Steven R, Blaha Michael J, Toth Peter P, Bittencourt Marcio S, Santos Raul D, Lotufo Paulo A, Chaker Layal, Bensenor Isabela M
机构信息
Center for Clinical and Epidemiological Research, Universidade de Sao Paulo (USP), São Paulo 05508-000, SP, Brazil.
Division of Endocrinology, Escola Paulista de Medicina/Universidade Federal de São Paulo (UNIFESP), São Paulo 04022-001, SP, Brazil.
出版信息
Metabolites. 2025 Sep 11;15(9):606. doi: 10.3390/metabo15090606.
BACKGROUND
Recently, a new biomarker index that reflects inflammation and protein energy malnutrition has emerged as a predictor of mortality in cardiovascular diseases. The metabolic vulnerability index (MVX) derives from blood-based inflammation (IVX) and malnutrition (MMX) markers measured by nuclear magnetic resonance (NMR) spectroscopy. We aimed to explore the association of subclinical hypothyroidism and thyroid-related parameters with IVX, MMX, and MVX scores.
METHODS
This cross-sectional study used the baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). Individuals with normal thyroid function and subclinical hypothyroidism were included. Thyroid-related parameters-thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), the FT3-FT4 ratio, and antithyroperoxidase antibodies (TPOAb)-were the explanatory variables. The primary outcomes, MVX, MMX, and IVX scores, were analyzed as continuous variables. Linear regression analyses were performed for both univariate and multivariable models, with sensitivity and subgroup analyses applied to assess robustness.
FINDINGS
There were 3979 participants (51.4% female) with a mean age of 51.26 (SD: 9.02) years. After full adjustment for potential confounder variables, FT3 levels [B: -1.37 (-2.43;-0.31) = 0.011] and the FT3-FT4 ratio [B: -0.90 (-1.79;-0.01) = 0.047] were inversely associated with MVX scores. FT3 levels were also inversely associated with IVX [B: -1.32 (-2.39;-0.24) = 0.017]. These results were consistent in euthyroid individuals and those with cardiometabolic diseases. In the sex-stratified analysis, FT3 levels were inversely associated with MVX, MMX, and IVX scores for men.
CONCLUSION
Lower FT3 levels and the FT3-FT4 ratio were associated with a higher metabolic vulnerability in our cohort. Our study sheds light on the importance of metabolic surveillance in these patients, especially for men with cardiometabolic diseases.
背景
最近，一种反映炎症和蛋白质能量营养不良的新生物标志物指数已成为心血管疾病死亡率的预测指标。代谢脆弱性指数（MVX）源自通过核磁共振（NMR）光谱测量的基于血液的炎症（IVX）和营养不良（MMX）标志物。我们旨在探讨亚临床甲状腺功能减退症及甲状腺相关参数与IVX、MMX和MVX评分之间的关联。
方法
这项横断面研究使用了巴西成人健康纵向研究（ELSA - Brasil）的基线数据。纳入甲状腺功能正常和亚临床甲状腺功能减退症患者。甲状腺相关参数——促甲状腺激素（TSH）、游离甲状腺素（FT4）、游离三碘甲状腺原氨酸（FT3）、FT3 - FT4比值和抗甲状腺过氧化物酶抗体（TPOAb）——作为解释变量。主要结局MVX、MMX和IVX评分作为连续变量进行分析。对单变量和多变量模型均进行线性回归分析，并应用敏感性和亚组分析来评估稳健性。
结果
共有3979名参与者（51.4%为女性），平均年龄为51.26（标准差：9.02）岁。在对潜在混杂变量进行完全调整后，FT3水平[B： - 1.37（- 2.43；- 0.31），P = 0.011]和FT3 - FT4比值[B： - 0.90（- 1.79；- 0.01），P = 0.047]与MVX评分呈负相关。FT3水平也与IVX呈负相关[B： - 1.32（- 2.39；- 0.24），P = 0.017]。这些结果在甲状腺功能正常个体和患有心脏代谢疾病的个体中是一致的。在按性别分层分析中，FT3水平与男性的MVX、MMX和IVX评分呈负相关。
结论
在我们的队列中，较低的FT3水平和FT3 - FT4比值与较高的代谢脆弱性相关。我们的研究揭示了对这些患者进行代谢监测的重要性，尤其是对患有心脏代谢疾病的男性。
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