老年居民健康体检中甲状腺功能异常的分布及管理策略

谢骏哲; 张春连; 范纪锋; 冯晓云

doi:10.16766/j.cnki.issn.1674-4152.004255

老年居民健康体检中甲状腺功能异常的分布及管理策略

doi: 10.16766/j.cnki.issn.1674-4152.004255

谢骏哲^{1, 2},
张春连³,
范纪锋³,
冯晓云^{1, 4, ,}

1.
上海交通大学医学院附属上海市第一人民医院内分泌科，上海 200080
2.
上海交通大学医学院，上海 200025
3.
上海市松江区洞泾镇社区卫生服务中心，上海 201619
4.
上海市嘉定区江桥医院内分泌科，上海 201803

基金项目:

上海市科技计划项目 20ZR1444400

上海市松江区科技攻关项目 2023SJKJGG043

详细信息

通讯作者:
冯晓云，E-mail：xiaoyun.feng@shgh.cn

中图分类号: R581 R161.7
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出版历程
- 收稿日期: 2024-10-23
- 网络出版日期: 2026-01-07

Distribution and management strategies of thyroid dysfunction among elderly residents based on health examinations

XIE Junzhe^{1, 2},
ZHANG Chunlian³,
FAN Jifeng³,
FENG Xiaoyun^{1, 4
, ,}

1.
Department of Endocrinology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China

摘要

摘要: 目的随着年龄增长，老年人甲状腺功能异常发生率升高，但不同促甲状腺激素(TSH)界值对健康结局的影响尚存争议。本研究基于2023年上海市松江区洞泾镇3 830名老年居民健康体检数据，探讨甲状腺功能异常分布及基层管理策略。方法以TSH 4.2、6.0、8.0、10.0 mIU/L为亚临床甲减(SCH)诊断界值，比较不同甲状腺功能状态下居民健康状况和认知能力，并分析SCH组与甲状腺功能正常对照组的临床及实验室指标差异。结果在所有TSH诊断界值下，SCH组红细胞分布宽度均高于对照组(P＜0.05)；当TSH≥6.0 mIU/L时，SCH组心脏增大发生率为45.6%(47人)，高于对照组[29.8%(31人)，χ²=5.518，P=0.019]；当TSH≥8.0 mIU/L时，SCH组高血压患病率为52.7%(29人)，高于对照组[30.9%(17人), χ²=5.380，P=0.020]，糖尿病患病率为5.5%(3人)，低于对照组[18.2%(10人), χ²=4.274，P=0.039]；当TSH≥10.0 mIU/L时，SCH组与对照组在腰围、血脂水平及窦性心动过缓发生率方面差异均有统计学意义(P＜0.05)。结论上海市松江区洞泾镇老年居民甲状腺健康状况优于全国平均水平。当TSH＜10.0 mIU/L时，该人群总体健康和认知能力差异无统计学意义；老年甲减患者需定期监测，避免药物过量导致的医源性危害。
- 亚临床甲减 /
- 老年人 /
- 健康体检 /
- 甲状腺 /
- 社区管理
Abstract: Objective The prevalence of thyroid dysfunction increases with age, but the impact of different thyroid stimulating hormone (TSH) thresholds on health outcomes remains controversial. This study investigates the distribution of thyroid dysfunction and explore primary care management strategies based on the health examination data of 3 830 elderly residents from Dongjing Town, Songjiang District, Shanghai, in 2023. Methods Subclinical hypothyroidism (SCH) was defined using TSH cut-offs of 4.2, 6.0, 8.0, and 10.0 mIU/L. Health status and cognitive function were compared among residents with different thyroid function states, and clinical and laboratory indicators were analyzed between the SCH group and the euthyroid control group. Results At all TSH thresholds, the red cell distribution width (RDW) in the SCH group was significantly higher than in controls (P < 0.05). When TSH≥6.0 mIU/L, the prevalence of cardiac enlargement in the SCH group was 45.6% (47/103), higher than 29.8% (31/104) in control group (χ²=5.518, P=0.019). When TSH≥8.0 mIU/L, hypertension prevalence was 52.7% (29/55) in the SCH group versus 30.9% (17/55) in control group (χ²=5.380, P=0.020), while diabetes prevalence was 5.5% (3/55) versus 18.2% (10/55, χ²=4.274, P=0.039). When TSH≥10.0 mIU/L, significant differences were observed between SCH and control groups in waist circumference, lipid profiles, and the incidence of sinus bradycardia (P < 0.05). Conclusion Elderly residents in Dongjing Town, Songjiang District, Shanghai, have better thyroid health than the national average. When TSH < 10.0 mIU/L, overall health status and cognitive function show no significant differences. Regular monitoring of elderly hypothyroid patients is recommended to prevent iatrogenic risks from overtreatment.
- Subclinical hypothyroidism /
- Elderly /
- Health examination /
- Thyroid gland /
- Community management

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表 1 3 830名体检人群健康状况及甲状腺功能特征

Table 1. General health status and thyroid function characteristics of 3 830 individuals undergoing physical examination

项目	甲状腺功能正常 (n=3 411)	临床型甲亢 (n=13)	亚临床甲亢 (n=56)	临床型甲减 (n=12)	亚临床甲减 (n=330)	统计量	P值
年龄(x±s，岁)	67.25±7.40	67.85±9.66	66.21±7.71	66.75±6.65	69.42±8.21	4.635^a	＜0.001
性别[例(%)]						33.994^b	＜0.001
男性	1 420(41.6)	3(23.1)	18(32.1)	2(16.7)	83(25.2)
女性	1 991(58.4)	10(76.9)	38(67.95)	10(83.3)	247(74.8)
高血压[例(%)]	1 612(47.3)	7(53.8)	28(50.0)	6(50.0)	144(43.6)	1.585^b	0.208
糖尿病[例(%)]	465(13.6)	2(15.4)	12(21.4)	0	39(11.8)	0.779^b	0.377
BMI(x±s)	24.80±3.28	24.73±3.25	24.89±3.96	24.96±2.84	25.10±3.72	1.371^a	0.171
腰围(x±s，cm)	81.81±8.17	83.85±8.26	81.82±9.09	81.42±7.79	82.34±8.45	1.057^a	0.291
臀围(x±s，cm)	91.13±6.18	92.85±6.97	90.80±7.25	89.42±5.66	91.38±6.66	0.680^a	0.497
SBP(x±s，mmHg)	138.72±18.28	137.45±20.74	140.54±18.30	142.30±29.14	141.09±19.05	2.139^a	0.032
DBP(x±s，mmHg)	80.84±9.39	77.64±9.81	80.76±10.30	79.10±13.26	81.18±9.78	0.596^a	0.551
心率(x±s，次/min)	74.80±5.57	76.82±8.70	74.91±4.97	73.18±8.84	74.77±5.82	0.106^a	0.916
FT4(x±s，pmol/L)	16.60±2.15	34.79±11.58	19.64±2.77	7.34±2.09	15.62±2.34	7.852^a	＜0.001
TSH[M(P₂₅, P₇₅)，mIU/L]	1.980(1.450，2.650)	0.005(0.005，0.017)	0.254(0.082，0.402)	31.850(19.800，81.850)	5.185(4.670，6.213)	30.041^c	＜0.001
骨钙素(x±s，μg/L)	8.66±4.25	10.11±5.21	10.10±8.33	8.93±3.34	8.99±3.85	1.472^a	0.142
TC(x±s，mmol/L)	5.14±1.07	4.33±1.67	5.17±0.94	5.62±1.70	5.21±1.23	1.004^a	0.315
TG(x±s，mmol/L)	1.64±1.32	1.30±0.64	1.48±0.99	1.88±0.84	1.72±1.39	1.076^a	0.283
HDL(x±s，mmol/L)	1.49±0.38	1.40±0.43	1.54±0.43	1.44±0.35	1.52±0.41	1.390^a	0.164
LDL(x±s，mmol/L)	3.18±0.96	2.55±1.48	3.20±0.91	3.57±1.47	3.18±1.09	0.054^a	0.957
ALT[M(P₂₅, P₇₅)，U/L]	16.79(12.95，22.10)	20.13(13.01，25.33)	15.54(11.16，23.18)	25.42(15.42，32.47)	15.94(12.39，22.13)	1.070^c	0.285
AST[M(P₂₅, P₇₅)，U/L]	21.23(17.99，25.14)	19.97(18.21, 25.91)	20.56(18.14，26.37)	30.75(23.74，41.51)	11.97(9.80，25.40)	2.060^c	0.039
肌酐(x±s，μmol/L)	75.76±20.31	64.09±13.00	77.52±26.52	74.65±13.61	77.96±23.53	1.851^a	0.064
BUN(x±s，mmol/L)	5.98±1.63	5.83±0.96	6.49±2.62	5.20±1.18	6.20±2.21	1.814^a	0.071
尿酸(x±s，μmol/L)	322.53±85.61	307.30±81.73	320.24±83.89	322.84±69.87	330.2±94.30	1.540^a	0.124
空腹血糖(x±s，mmol/L)	6.15±1.57	6.26±1.28	6.14±1.77	5.56±0.66	6.17±1.53	0.269^a	0.788
Hcy[M(P₂₅, P₇₅)，μmol/L]	11.72(9.61，14.60)	10.93(8.18，13.71)	11.77(9.35，14.71)	11.97(9.80，25.40)	12.00(10.03，15.80)	2.708^c	0.007
红细胞分布宽度(x±s)	46.77±2.91	44.94±3.33	46.55±3.35	51.11±5.98	47.30±6.02	1.568^a	0.118
Hb(x±s，g/L)	146.72±13.67	142.92±12.72	147.17±14.92	134.08±12.58	142.62±14.48	5.132^a	＜0.001
心脏增大[例(%)]	842(24.7)	4(30.8)	12(21.4)	3(25.0)	114(34.5)	15.425^b	＜0.001
窦性心动过缓[例(%)]	361(10.6)	1(7.7)	7(12.5)	5(41.7)	37(11.2)	0.141^b	0.707
认知问卷评分≥3[例(%)]	282(8.3)	0	5(8.9)	1(8.3)	32(9.7)	0.800^b	0.371
注：统计量和P值为亚临床甲减组与甲状腺功能正常组比较。^a为t值，^b为χ²值，^c为Z值。1 mmHg=0.133 kPa。

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表 2 TSH≥10.0 mIU/L界值下SCH组与对照组临床特征比较

Table 2. Comparison of clinical characteristics between SCH and control groups defined by TSH ≥10.0 mIU/L

组别	例数	腰围 (x±s，cm)	FT4 (x±s，pmol/L)	TSH [M(P₂₅, P₇₅)，mIU/L]	TC (x±s，mmol/L)	TG (x±s，mmol/L)	HDL (x±s，mmol/L)	LDL (x±s，mmol/L)	窦性心动过缓[例(%)]
组别	例数	腰围 (x±s，cm)	FT4 (x±s，pmol/L)	TSH [M(P₂₅, P₇₅)，mIU/L]	TC (x±s，mmol/L)	TG (x±s，mmol/L)	HDL (x±s，mmol/L)	LDL (x±s，mmol/L)	是	否
亚临床甲减组	27	80.19±7.42	11.84±5.00	14.50(10.90，34.20)	5.61±1.12	1.49±0.69	1.69±0.67	3.54±1.00	10(37.0)	17(63.0)
对照组	27	85.59±7.94	14.83±2.28	8.57(8.29，9.12)	4.77±1.30	1.96±0.85	1.38±0.31	2.82±1.24	2(7.4)	25(92.6)
统计量		2.585^a	2.828^a	6.306^b	2.544^a	2.234^a	2.327^a	2.167^a	6.857^c
P值		0.013	0.008	＜0.001	0.014	0.030	0.024	0.035	0.009
注：^a为t值，^b为Z值，^c为χ²值。

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