CAJ | 학술논문

目的探讨正常甲状腺功能者5年随访时促甲状腺激素(TSH)的异常率和影响这一人群TSH发生异常的因素.方法 3个不同碘营养背景的农村社区的3403例甲状腺功能正常者中,80.1%(2727例)接受了筛查后的5年随访,测定其血清TSH和甲状腺自身抗体水平.结果随访对象中,68例(2.5%)TSH异常降低(<0.3 mU/L),64例(2.4%)TSH异常增高(>4.8 mU/L).logistic回归分析显示,初访时甲状腺过氧化物酶抗体(TPOAb)阴性而随访时阳性(OR=5.5)、初访和随访TPOAb均阳件(OR=4.0)、随访时甲状腺球蛋白抗体(TgAb)阳性(OR=3.7)和初访时TSH<1.0 mU/L(OR=2.6)是TSH异常降低的危险因素;而缺碘基础上补碘至碘足量(OR=4.8)、长期碘过量(OR=3.9)、随访时TgAb阳性(OR=3.7)、初访和随访TPOAb均阳性(OR=3.6)、初访时TPOAb阴性而随访时阳性(OR=2.7)和TSH>1.9 mU/L(OR=2.6)是TSH异常增高的危险因素.结论与轻度碘缺乏相比,碘足量和碘过量足TSH由正常转为异常升高的危险因素,缺碘基础上补碘至碘足量导致TSH转为异常升高的危险性更高于长期碘过量.初访TSH处于1.0～1.9 mU/L时,5年随访时发生TSH异常的几率最小.
목적 탐토정상갑상선공능자5년수방시촉갑상선격소(TSH)적이상솔화영향저일인군TSH발생이상적인소.방법 3개불동전영양배경적농촌사구적3403례갑상선공능정상자중,80.1%(2727례)접수료사사후적5년수방,측정기혈청TSH화갑상선자신항체수평.결과 수방대상중,68례(2.5%)TSH이상강저(<0.3 mU/L),64례(2.4%)TSH이상증고(>4.8 mU/L).logistic회귀분석현시,초방시갑상선과양화물매항체(TPOAb)음성이수방시양성(OR=5.5)、초방화수방TPOAb균양건(OR=4.0)、수방시갑상선구단백항체(TgAb)양성(OR=3.7)화초방시TSH<1.0 mU/L(OR=2.6)시TSH이상강저적위험인소;이결전기출상보전지전족량(OR=4.8)、장기전과량(OR=3.9)、수방시TgAb양성(OR=3.7)、초방화수방TPOAb균양성(OR=3.6)、초방시TPOAb음성이수방시양성(OR=2.7)화TSH>1.9 mU/L(OR=2.6)시TSH이상증고적위험인소.결론 여경도전결핍상비,전족량화전과량족TSH유정상전위이상승고적위험인소,결전기출상보전지전족량도치TSH전위이상승고적위험성경고우장기전과량.초방TSH처우1.0～1.9 mU/L시,5년수방시발생TSH이상적궤솔최소.
Objective To determine the factors that influence the development of abnormal thyrotropin (TSH) level in an euthyroid population.Methods We conducted a follow-up study in 3 communities with different iodine status.Of the 3403 euthyroid subjects at baseline screened in 1999,80.1% ( n = 2727 ) was visited and sampled in 2004 for measuring TSH,thyroid peroxidase antibody (TPOAb) and thyroglobulin antibody (TgAb).Results Iodine status in the 3 communities were stable.Decreased TSH level( <0.3 mU/L) developed in 2.5% (n =68) of sampled subjects,while raised TSH level( > 4.8 mU/L) in 2.4% (n = 64).A logistic analysis showed that risk factors for developing decreased TSH level included positive conversion of TPOAb (OR = 5.5 ),positive TPOAb both in 1999 and in 2004 ( OR = 4.0),positive TgAb in 2004 ( OR = 3.7) and TSH < 1.0 mU/L in 1999 ( OR = 2.6).Risk factors involved in developing raised TSH level included iodine status of Zhangwu community ( OR = 4.1 ),iodine status of Huanghua community ( OR = 3.9),positive TgAb in 2004 ( OR = 3.7 ),positive TPOAb both in 1999 and 2004 (OR =3.6),positive conversion of TPOAb (OR =2.7) and TSH > 1.9 mU/L in 1999 (OR = 2.6 ).Conclusions Exposure to long-term iodine excess imposes danger of developing hypothyroidism.The risk will be even higher when exposing to iodine adequacy after correction of iodine deficiency.An interval between 1.0 and 1.9 mU/L of TSH level was optimul with the least probability of developing abnormal TSH level.