目的:探讨甲状腺结节(TN)人群中促甲状腺激素(TSH)水平与代谢综合征(MS)发生的关联性。方法:采用整群抽样法从各科室抽取723例TN患者,根据纳入排除标准最终确定487例参与统计分析。根据四分位数法将研究对象TSH 分为低水平、中水平、稍高水平、高水平4个亚组;根据MS诊断标准和BMI水平,将人群分为MS组和非MS组以及超重组和非超重组,并比较不同组间指标差异;应用Logistic回归分析探究MS发生的独立危险因素及不同TSH水平MS患病风险;受试者工作曲线(ROC)探讨TSH作为MS潜在诊断标志物的价值。结果:在TN 中,MS 的检出率为40.86%(199/487),且随着TSH 水平的升高,MS的检出率逐渐增高(趋势χ2=98.034,P＜0.001);多元Logistic回归分析显示TSH是影响MS的独立危险因素,并且与低水平TSH组比较,高水平组中MS的发生风险增加11.014倍;ROC曲线显示TSH的曲线下面积(AUC)为0.765,最佳TSH截断值为5.64 mIU/L,敏感度为84.4%,特异度为65.6%;MS组、超重组TN钙化发生率均大于非MS组和非超重组(P＜0.001);结论:(1)在TN人群中,TSH为MS发病的独立危险因素,可作为MS发生的潜在预测标志;(2)MS或肥胖患者合并TN发生恶化的概率更高。
Objective: To investigate the association between thyroid stimulating hormone (TSH) level and metabolic syndrome (MS) in patients with thyroid nodules (TN). Methods: A total of 723 patients with TN were selected from various departments by cluster sampling method, and 487 patients were finally determined to participate in the statistical analysis according to the inclusion and exclusion criteria. According to the quartile method, the TSH of the subjects was divided into four subgroups: low level, medium level, slightly higher level and high level. According to the diagnostic criteria of MS and BMI level, the population was divided into MS group and non-MS group, overweight group and non-overweight group, and the differences of indicators among different groups were compared. Logistic regression analysis was used to explore the independent risk factors of MS and the risk of MS with different TSH levels. The receiver operating curve (ROC) was used to explore the value of TSH as a potential diagnostic marker for MS. Results: In TN, the detection rate of MS was 40.86% (199/487), and the detection rate of MS gradually increased with the increase of TSH level (trend χ2=98.034, P＜0.001). Multivariate logistic regression analysis showed that TSH was an independent risk factor for MS, and the risk of MS in the high-level group was 11.014 times higher than that in the low-level TSH group. The ROC curve showed that the area under the curve (AUC) of TSH was 0.765, the optimal TSH cutoff value was 5.64 mIU/L, the sensitivity was 84.4%, and the specificity was 65.6%. The incidence of TN calcification in MS group and overweight group was higher than that in non-MS group and non-overweight group (P＜0.001). Conclusion: (1) In the TN population, TSH is an independent risk factor for MS and can be used as a potential predictor of MS occurrence. (2) MS or obese patients have a higher probability of deterioration of TN.
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