Correlation between thyroid-stimulating hormone and risk factors and risk of cardiovascular and cerebrovascular diseases in the elderly
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摘要: 目的 评估正常范围内促甲状腺激素(TSH)水平与老年心脑血管病危险因素及患病风险之间的关联。方法 采用回顾性横断面研究分析我院老年心脑血管病患者和健康体检人群的临床资料，基于正常范围内TSH水平分析TSH水平与体重指数(BMI)、高血压、糖尿病、血脂异常等心脑血管病危险因素的相关性。纳入≥60岁以上的研究对象共2 805例，其中心脑血管病患者为观察组(1 756例)，健康体检人群为对照组(1 049例)，比较分析两组对象的临床资料，采用单因素和多因素logistic回归模型分析老年人发生心脑血管病的影响因素，通过受试者工作特征(ROC)曲线分析正常范围内TSH水平对老年心脑血管病的预测效果。结果 Spearman相关性分析显示，正常范围内TSH水平与血脂异常、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)均呈正相关(r=0.519、0.475、0.383、0.434，均P<0.001)，与高密度脂蛋白胆固醇(HDL-C)呈负相关(r=-0.201，P<0.001)。观察组男性比例、高血压比例、糖尿病比例、血脂异常比例、BMI、TC、LDL-C及TSH水平均显著高于对照组，HDL-C明显低于对照组(均P<0.001)。Logistic回归模型分析发现，老年心脑血管病风险随着正常范围内TSH水平的增加而显著增高(OR=2.920，95%CI：2.560~3.329，P<0.001)。ROC曲线分析表明，正常范围内TSH水平对心脑血管病预测价值的曲线下面积为0.733(95%CI：0.714~0.751)。结论 正常范围内TSH水平与心脑血管病部分危险因素具有相关性，高水平TSH对老年心脑血管病有较佳的预测效果，重视老年人群甲状腺功能的动态检测有助于降低心脑血管病风险。Abstract: Objective To determine the correlation between thyroid-stimulating hormone (TSH) levels within the normal range and risk factors as well as morbidity for cardiovascular and cerebrovascular disease in elderly individuals.Methods A retrospective cross-sectional study was used to analyze the clinical data of elderly patients with cardiovascular and cerebrovascular diseases, as well as a healthy physical examination group in our hospital. The correlation between TSH levels within the normal range and risk factors for cardiovascular and cerebrovascular diseases, including body mass index (BMI), hypertension, diabetes, and dyslipidemia, was analyzed. A total of 2 805 subjects aged ≥ 60 years old were included, with 1 756 patients in the observation group and 1 049 healthy individuals in the control group. The clinical data of the two groups were compared. Univariate and multivariate logistic regression models were used to analyze the influencing factors of cardiovascular and cerebrovascular disease in the elderly. And the predictive effect of TSH level on cardiovascular and cerebrovascular disease in the elderly within normal TSH range was analyzed by the receiver working characteristic (ROC) curve.Results Spearman analysis showed that the TSH level within normal range was positively correlated with dyslipidemia, total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (LDL-C) (r=0.519、0.475, 0.383, 0.434, all P<0.001), and negatively correlated with high-density lipoprotein cholesterol (HDL-C) (r=-0.201, P<0.001). The proportion of men, hypertension, diabetes, dyslipidemia, BMI, TC, LDL-C and TSH levels in the observation group were significantly higher than those in the control group, and HDL-C was significantly lower than that in the control group (all P<0.001). Logistic regression model analysis found that the risk of cardiovascular and cerebrovascular diseases in the elderly increased significantly with the increase of TSH level within the normal range (OR=2.920, 95%CI: 2.560-3.329, P<0.001). ROC curve analysis showed that the area under the curve for the predictive value of TSH level within normal range on cardiovascular and cerebrovascular disease was 0.733 (95%CI: 0.714-0.751).Conclusion TSH levels within the normal range is correlated with some risk factors for cardiovascular and cerebrovascular diseases. Elevated TSH levels demonstrate a stronger predictive capacity for cardiovascular and cerebrovascular diseases in the elderly. Monitoring thyroid function dynamically in the elderly population may contribute to a reduced risk of such diseases.
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图 1 TSH水平预测心脑血管病的ROC曲线
Figure 1. The ROC curve for predicting cardiovascular and cerebrovascular diseases using TSH levels
表 1 对照组和观察组临床资料比较
Table 1. Clinical data
例(%), X±S, M(Q1, Q3) 项目 对照组(1 049例) 观察组(1 756例) 统计量 P值 男性 540(51.48) 979(55.75) 13.509 ＜0.001 年龄/岁 70.39±7.05 70.83±7.26 1.589 0.112 高血压 408(38.89) 892(50.80) 37.417 ＜0.001 糖尿病 294(28.03) 693(39.46) 37.672 ＜0.001 血脂异常 501(47.76) 1065(60.65) 44.242 ＜0.001 BMI/(kg/m2) 24.63(22.52，26.26) 24.74(22.37，26.82) 2.297 0.022 空腹血糖/(mmol/L) 6.96±2.85 6.99±2.94 0.285 0.776 总胆红素/(μmol/L) 14.58±6.90 14.67±8.05 0.278 0.781 尿酸/(μmol/L) 360.26±108.81 360.81±110.44 0.129 0.898 TC/(mmol/L) 4.28±1.15 4.47±1.40 3.453 ＜0.001 TG/(mmol/L) 1.36(1.08，1.93) 1.66(1.44，1.86) 1.422 0.155 HDL-C/(mmol/L) 1.28±0.30 1.19±0.26 -8.925 ＜0.001 LDL-C/(mmol/L) 1.62±0.59 1.82±0.87 16.981 ＜0.001 ApoA1/(g/L) 1.23(1.11，1.36) 1.22(1.10，1.35) -1.719 0.086 ApoB/(g/L) 1.04±0.19 1.05±0.23 0.283 0.777 TSH/(μIU/L) 1.33(0.92，1.58) 1.98(1.29，2.64) 22.706 ＜0.001 FT3/(pmol/L) 4.72(4.25，5.13) 4.67(4.27，5.06) -1.349 0.178 FT4/(pmol/L) 14.95(13.60，16.51) 15.09(13.64，16.58) -0.260 0.794 
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表 2 正常范围内TSH水平与心脑血管病发生关系的logistic回归分析结果
Table 2. The correlation between TSH levels within normal range and cardiovascular and cerebrovascular diseases analyzed by logistic analysis
项目 OR值 95%CI P值 模型1 3.063 2.718~3.450 ＜0.001 模型2 3.046 2.703~3.432 ＜0.001 模型3 2.920 2.560~3.329 ＜0.001
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表 3 模型3的logistic回归分析结果
Table 3. Logistic analysis results of the Model 3
变量 OR值 95%CI P值 男性 1.283 1.075~1.531 0.006 BMI 1.005 0.975~1.037 0.729 无高血压 0.622 0.520~0.745 ＜0.001 无糖尿病 0.617 0.511~0.744 ＜0.001 TC 1.143 1.070~1.220 ＜0.001 HDL-C 0.402 0.284~0.569 ＜0.001 LDL-C 7.072 5.198~9.621 ＜0.001 ApoA1 1.358 0.872~2.114 0.176 TSH 2.920 2.560~3.329 ＜0.001
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