上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

亚临床甲状腺功能异常与高尿酸血症的临床研究

黄 融，曹 勤，顾静莉，马嘉骅，顾伟威，范竹萍   

  1. 上海交通大学 医学院附属仁济医院健康保健中心， 上海 200127
  • 出版日期:2013-10-28 发布日期:2013-10-31
  • 通讯作者: 范竹萍, 电子信箱: zhuping_fan@163.com。
  • 作者简介:黄 融（1982—）， 女， 住院医师， 硕士; 电子信箱: sandra-hr@163.com。
  • 基金资助:

    上海市公共卫生重点学科建设计划资助项目（12GWZX0903）；上海市医学会健康管理分会与阿斯利康（中国）医学科研合作项目——健康管理课题

Clinical research of relationship between subclinical thyroid dysfunction and hyperuricemia

HUANG Rong, CAO Qin, GU Jing-li, MA Jia-hua, GU Wei-wei, FAN Zhu-ping   

  1. Department of Health Care Centre, Renji Hospital,  Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • Online:2013-10-28 Published:2013-10-31
  • Supported by:

    Shanghai Public Health Key Discipline Construction Plan, 12GWZX0903; Medical Research Cooperation Plan of Shanghai Medical Institute and Astrazeneca (China)

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摘要：

目的 分析人群中亚临床甲状腺功能异常的患病情况及其与高尿酸血症的关系。方法 以18 731名健康体检者作为研究对象，化学发光免疫分析法测定血清促甲状腺素（TSH）、游离甲状腺素（FT4）和游离三碘甲腺原氨酸（FT3），尿酸酶-过氧化物酶耦联法测定血清尿酸(SUA)水平。根据血清TSH的95%可信区间(95%CI)将体检人群分为亚临床甲状腺功能亢进组（亚临床甲亢组，TSH降低）、正常组和亚临床甲状腺功能减退组（亚临床甲减组，TSH升高），对各项检测指标进行组间比较，对血清TSH水平与高尿酸血症患病率进行Logistic回归分析。结果 在研究人群中，平均血清TSH水平为（1.54±1.13）mIU/L，95%CI 0.69~3.67 mIU/L；亚临床甲亢组（TSH≤0.69 mIU）、正常组（0.69 mIU/L<TSH＜3.67 mIU/L）和亚临床甲减组（TSH≥3.67 mIU/L）的人数分布为172、18 167和392；亚临床甲状腺功能异常的患病率为3.01%（564/18 731）。随着血清TSH水平的升高，体质量指数（BMI）与SUA水平也逐渐升高。与正常组比较，亚临床甲亢组的SUA、总胆固醇和低密度脂蛋白（LDL）浓度降低，而高密度脂蛋白（HDL）浓度显著升高；亚临床甲减组的BMI、血压以及SUA和血清三酰甘油浓度升高，而HDL浓度显著降低；组间比较差异均有统计学意义（P<0.05）。Logistic回归分析结果显示：当FT4和FT3浓度处于正常范围，血清TSH水平升高与高尿酸血症患病率独立相关（OR=2.834，95%CI 1.445~5.556)。结论 体检人群中血清TSH参考值范围为0.69~3.67 mIU/L，血清TSH升高与代谢紊乱有关，亚临床甲状腺功能减退是高尿酸血症的危险因素。

关键词: 促甲状腺素, 亚临床甲状腺功能减退, 高尿酸血症

Abstract:

Objective To investigate the relationship between subclinical thyroid dysfunction and hyperuricemia. Methods A total of 18 731 subjects undergoing medical examinations were selected. Serum thyroid stimulation hormone (TSH), free thyroxine (FT4) and free triiodothyronine (FT3) were measured by chemiluminescence immunoassay, and serum uric acid was examined by uricase-peroxidase coupling method. According to the 95% confidence interval (95%CI) of serum TSH, the study population was divided into subclinical hyperthyroidism group (decreased TSH), normal group and subclinical hypothyroidism group (increased TSH), the detected parameters were compared among groups, and Logistic regression analysis was conducted between serum TSH and incidence of hyperuricemia. Results The mean serum TSH of the study population was (1.54±1.13) mIU/L, and the 95%CI was 0.69-3.67 mIU/L. The numbers of subjects in subclinical hyperthyroidism group (TSH≤0.69 mIU), normal group (0.69 mIU/L<TSH＜3.67 mIU/L) and subclinical hypothyroidism group (TSH≥3.67 mIU/L) were 172, 18 167 and 392 respectively. The incidence of subclinical thyroid dysfunction was 3.01% (564/1 8731). There was an ascending trend in body mass index (BMI) and serum uric acid with the elevation of serum TSH. Compared with normal group, the serum uric acid, total cholesterol and low density lipoprotein (LDL) were significantly lower, and the  high density lipoprotein (HDL) was significantly higher in subclinical hyperthyroidism group (P＜0.05).  Compared with normal group, the blood pressure, BMI, serum uric acid and serum triglyceride were significantly higher, and the HDL was significantly lower in subclinical hypothyroidism group (P＜0.05). Logistic regression analysis indicated that increased serum FSH was  independently associated with incidence of hyperuricemia (OR=2.834; 95%CI: 1.445-5.556) with the normal range of FT4 and FT3. Conclusion The reference range of serum TSH in subjects undergoing medical examinations is 0.69-3.67 mIU/L, and increased serum TSH is associated with metabolic disorders. Subclinical thyroid dysfunction is a risk factor for hyperuricemia.

Key words: thyroid stimulation hormone, subclinical hypothyroidism, hyperuricemia