上海市闵行区青春期女生甲状腺激素水平及影响因素分析

何丹丹; 温晓飒; 付晔; 徐晓莉; 陶士吉; 苏华林; 徐东丽; 王娜

doi:10.16835/j.cnki.1000-9817.2021.03.027

上海市闵行区青春期女生甲状腺激素水平及影响因素分析

doi: 10.16835/j.cnki.1000-9817.2021.03.027

何丹丹^{1, 2},
温晓飒^{1, 2},
付晔^{1, 2},
徐晓莉^{1, 2},
陶士吉^{1, 2},
苏华林^{1, 2, ,},
徐东丽^{1, 2},
王娜³

1.
上海市闵行区疾病预防控制中心公共卫生管理科，201101
2.
复旦大学公共卫生学院闵行分院
3.
复旦大学公共卫生学院流行病学教研室公共卫生安全教育部重点实验室

基金项目:

闵行区自然科学研究项目 2018MHZ010

复旦-闵行康联体合作项目 2019FM07

详细信息

作者简介:
何丹丹(1980-)，女，上海人，硕士，副主任医师，主要从事流行病学工作

通讯作者:
苏华林，E-mail：suhualin@sina.com

中图分类号: R 446 R 725.8
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- 被引次数: 0
出版历程
- 收稿日期: 2020-07-29
- 修回日期: 2020-12-15
- 网络出版日期: 2021-04-20
- 刊出日期: 2021-03-25

Analysis of thyroid hormone level and its influencing factors among pubertal girls in Minhang District of Shanghai

HE Dandan^{1, 2},
WEN Xiaosa^{1, 2},
FU Ye^{1, 2},
XU Xiaoli^{1, 2},
TAO Shiji^{1, 2},
SU Hualin^{1, 2
, ,},
XU Dongli^{1, 2},
WANG Na³

1.
Department of Public Health Managemet, Shanghai Minhang District Center for Disease Control and Prevention, Shanghai(201101), China

摘要

摘要: 目的观察上海市闵行区青春期女生的甲状腺激素水平，并探讨其可能的影响因素。方法 2019年1—3月采用分阶段整群抽样方法，分别在上海市闵行区东、南、北和中片各选取1所初中，将其新入学的预初女生共386名纳入研究。对研究对象进行体格检查，并收集其尿样及血样以检测尿碘及甲状腺激素水平；采用青春发育量表(Pubertal Development Scale，PDS)评价研究对象青春发育分期；采用多因素Logistic回归模型分析甲状腺激素水平的影响因素。结果研究对象尿碘质量浓度中位数为163.57(106.57，232.96)μg/L，血清促甲状腺激素(TSH)、血清总三碘甲状腺原氨酸(TT3)、血清游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素(FT4)几何均值分别为0.29 mU/L、0.26 nmol/L、0.68 pmol/L、1.18 pmol/L，血清总甲状腺素(TT4)均值为91.64 nmol/L。甲状腺球蛋白抗体(TGAb)以及甲状腺过氧化物酶抗体(TPOAb)的偏高率为6.22%及4.15%。TGAb和TPOAb均偏高率为3.68%。青春发动期和青春后期TT4水平均低于青春前期(OR值分别为0.47，0.43)，肥胖女生具有较高的TT3水平(OR=9.08，95%CI=1.52~54.07)；运动时间增加(0.5~1，>1 h/d)，FT4水平增高(OR值分别为2.45，2.19)。TGAb和TPOAb同时偏高者中TSH水平较高；TGAb偏高TPOAb正常的学生中，TT4和FT4水平较高。结论碘适宜地区青春女生甲状腺激素水平与青春期发育、肥胖和运动相关；TSH、FT4和TT4水平与TGAb、TPOAb水平相关。
- 青春期 /
- 甲状腺激素类 /
- 生长和发育 /
- 回归分析 /
- 学生 /
- 女(雌)性
Abstract: Objective To investigate thyroid hormone concentration and associated factors among pubertal girls in Minhang District of Shanghai. Methods From January to March 2019, a stratified sampling method was used to select junior high schools from the east, south, north, and middle areas in Minhang district. A total of 386 girls of grade 6 in selected schools were included in the study. Physical examination was conducted, and their urine and blood samples were collected to determine urinary iodine concentration (UIC) and thyroid function. Puberty Development Self-rating Scale (PDS) was used to define the pubertal stage. Logistic regression models were conducted to analyze the associations between pubertal stage and thyroid function. Results The median urinary iodine concentration was 163.57(106.57, 232.96) μg/L. The geometric mean values of TSH, TT3, FT3 and FT4 were 0.29 mU/L, 0.26 nmol/L, 0.68 pmol/L and 1.18 pmol/L.The mean value of TT4 was 91.64 nmol / L. The abnormal rates of TGAb and TPOAb were 6.22% and 4.15%. The rate of abnormal TGAb combined with abnormal TPOAb was 3.68%. Girls in puberty and post-puberty had the lower level of TT4 (OR=0.47, 0.43) as compared with girls in pre-puberty stage. Obese girls had higher level of TT3(OR=9.08, 95%CI=1.52-54.07). With the increase of exercise time(0.5-1, >1 h/d), FT4 level was increased (OR=2.45, 2.19). TSH levels were significantly higher in girls with higher TGAb and TPOAb. Girls had higher TT4 or FT4 levels if their TGAb levels were higher and TPOAb levels were normal. Conclusion There is an association between pubertal stage, obesity, exercise and thyroid function in school-aged girls during puberty in iodine sufficient areas. TSH, FT4 and TT4 levels are correlated with TGAb and TPOAb levels.
- Puberty /
- Thyroid hormones /
- Growth and development /
- Regression analysis /
- Students /
- Female

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表 1 不同组别青春期女生甲状腺指标水平比较[M(P₂₅~P₇₅)]

Table 1. Comparison of thyroid hormone level in different group of school-aged girls[M(P₂₅~P₇₅)]

组别	人数	统计值	UIC/(μg·L^-1)	TSH/(mU·L^-1)	TT3/(nmol·L^-1)	TT4/(nmol·L^-1)	FT3/(pmol·L^-1)	FT4/(pmol·L^-1)
青春发育分期
青春前期	69		147.06(86.44~215.89)	0.30(0.24~0.36)	0.29(0.26~0.32)	95.72(91.95~99.49)	0.71(0.69~0.74)	1.19(1.17~1.21)
青春发动期	116		155.77(113.32~230.43)	0.29(0.24~0.34)	0.28(0.25~0.30)	91.28(88.02~94.54)	0.69(0.67~0.71)	1.17(1.16~1.18)
青春后期	201		179.74(111.26~242.67)	0.28(0.25~0.31)	0.25(0.23~0.26)	90.44(87.86~93.01)	0.67(0.65~0.68)	1.18(1.17~1.19)
		Z值	4.77	0.10	3.74	2.29	5.35	1.47
		P值	0.09	0.90	0.03	0.10	0.01	0.23
家庭人均月收入/元
≤3 000	67		179.89(119.50~256.86)	0.29(0.24~0.34)	0.29(0.26~0.32)	89.13(84.70~93.56)	0.70(0.68~0.73)	1.18(1.17~1.20)
> 3 000	319		159.57(103.31~232.00)	0.29(0.26~0.31)	0.26(0.24~0.27)	92.16(90.20~94.12)	0.68(0.67~0.69)	1.18(1.17~1.18)
		Z值	0.49	0.00	3.53	1.59	2.27	0.75
		P值	0.49	0.98	0.06	0.21	0.13	0.39
父母文化程度
本科以下	177		194.29(120.11~271.26)	0.29(0.26~0.33)	0.26(0.24~0.28)	89.03(86.37~91.68)	0.68(0.66~0.70)	1.18(1.17~1.19)
本科及以上	209		147.06(98.69~202.79)	0.28(0.25~0.31)	0.26(0.25~0.28)	93.85(91.45~96.24)	0.69(0.68~0.70)	1.18(1.17~1.19)
		Z值	18.08	0.35	0.07	7.08	1.26	0.02
		P值	0.00	0.56	0.79	0.01	0.26	0.90
家中二手烟暴露
是	198		158.54(100.01~235.64)	0.28(0.24~0.31)	0.26(0.24~0.28)	91.49(88.97~94.01)	0.69(0.67~0.70)	1.18(1.17~1.19)
否	183		170.51(116.00~231.14)	0.29(0.26~0.33)	0.27(0.25~0.29)	91.96(89.37~94.56)	0.68(0.67~0.70)	1.18(1.17~1.19)
		Z值	0.65	0.58	0.38	0.07	0.19	0.31
		P值	0.42	0.45	0.54	0.80	0.67	0.58
食用碘盐情况
碘盐为主	167		175.23(121.82~236.36)	0.29(0.26~0.33)	0.24(0.23~0.26)	89.55(86.80~92.29)	0.67(0.65~0.68)	1.18(1.17~1.19)
碘盐与非碘盐相当	73		180.96(115.86~243.58)	0.22(0.16~0.29)	0.29(0.26~0.32)	96.63(89.33~97.23)	0.70(0.68~0.73)	1.19(1.17~1.20)
非碘盐为主	141		142.59(90.33~142.59)	0.29(0.25~0.33)	0.28(0.26~0.30)	93.06(90.04~96.09)	0.70(0.68~0.72)	1.17(1.16~1.18)
		Z值	8.09	2.55	5.01	1.82	5.32	0.83
		P值	0.02	0.08	0.01	0.16	0.01	0.44
海产品食用频率
> 3次/周	45		151.89(117.64~227.93)	0.28(0.19~0.36)	0.25(0.21~0.29)	91.44(85.96~96.93)	0.68(0.64~0.71)	1.18(1.16~1.20)
> 1次/月且≤3次/周	249		159.57(102.39~231.57)	0.29(0.26~0.32)	0.26(0.25~0.28)	90.81(88.68~92.94)	0.69(0.67~0.70)	1.18(1.18~1.19)
几乎不吃	91		179.71(119.50~255.23)	0.28(0.24~0.33)	0.27(0.25~0.30)	93.99(89.87~98.11)	0.68(0.66~0.70)	1.18(1.17~1.20)
		Z值	0.92	0.10	0.67	1.06	0.30	0.18
		P值	0.63	0.91	0.51	0.35	0.75	0.84
每天睡眠时长/h
< 8	139		160.71(102.94~226.57)	0.27(0.24~0.31)	0.26(0.24~0.28)	93.38(90.55~96.21)	0.68(0.66~0.70)	1.17(1.16~1.19)
≥8	243		173.29(110.57~235.57)	0.29(0.26~0.32)	0.27(0.25~0.28)	90.78(88.46~93.10)	0.69(0.67~0.70)	1.18(1.17~1.19)
		Z值	0.98	0.33	0.01	1.89	0.21	0.54
		P值	0.32	0.57	0.91	0.17	0.65	0.46
每天运动时长/h
> 1	153		174.86(119.30~233.64)	0.27(0.23~0.31)	0.26(0.24~0.28)	90.57(87.70~93.44)	0.69(0.67~0.71)	1.18(1.17.1.19)
0.5~1	181		158.37(94.20~232.75)	0.29(0.26~0.32)	0.26(0.25~0.28)	92.81(90.09~95.52)	0.69(0.67~0.70)	1.18(1.17~1.19)
< 0.5	48		162.76(104.96~264.76)	0.29(0.20~0.39)	0.27(0.23~0.30)	90.94(86.63~95.25)	0.67(0.64~0.70)	1.15(1.13~1.17)
		Z值	1.42	1.20	0.01	0.49	0.22	0.95
		P值	0.49	0.30	0.99	0.61	0.81	0.39
BMI
消瘦	9		153.00(65.34~184.79)	0.38(0.25~0.52)	0.23(0.14~0.32)	97.53(84.39~110.68)	0.68(0.59~0.77)	1.17(1.12~1.21)
正常	252		165.21(105.98~239.96)	0.29(0.26~0.32)	0.27(0.25~0.28)	90.11(87.96~92.26)	0.69(0.68~0.70)	1.18(1.17~1.19)
超重	92		177.29(110.39~238.64)	0.28(0.23~0.33)	0.24(0.22~0.26)	95.36(91.41~99.30)	0.66(0.64~0.69)	1.18(1.16~1.19)
肥胖	33		147.86(110.96~201.41)	0.26(0.17~0.35)	0.30(0.26~0.33)	91.32(85.08~97.56)	0.71(0.68~0.75)	1.19(1.17~1.22)
		Z值	4.52	7.50	2.49	2.30	2.20	0.48
		P值	0.21	0.52	0.06	0.08	0.08	0.70
合计	386		163.57(106.57~232.96)	0.29(0.26~0.31)	0.26(0.25~0.28)	91.64(89.85~93.42)	0.68(0.67~0.70)	1.18(1.17~1.18)
注：父母中任一位学历为本科及以上归为本科及以上组；部分变量有缺失值。

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表 2 不同组别青春期女生TGAb、TPOAb偏高检出率比较

Table 2. Comparison the detection rates of abnormal TGAb and TPOAb in different groups of school-aged girls

组别	选项	人数	TGAb			TPOAb
组别	选项	人数	检出人数	χ²值	P值	检出人数	χ²值	P值
青春发育分期	青春前期	69	6(8.7)	1.08	0.61	3(4.35)	0.17	1.00
	青春发动期	116	7(6.03)			5(4.31)
	青春后期	201	11(5.47)			8(3.98)
家庭人均月收入/元	≤3 000	67	5(7.46)	0.04	0.85	3(4.48)	0.02	0.75
	> 3 000	319	19(5.96)			13(4.08)
父母文化程度	本科以下	177	11(6.21)	0.00	0.99	6(3.39)	0.47	0.49
	本科及以上	209	13(6.22)			10(4.78)
家中二手烟暴露	是	198	11(5.56)	0.00	0.99	8(4.04)	0.01	0.92
	否	183	12(6.56)			7(3.83)
食用碘盐情况	碘盐为主	167	11(6.59)	1.62	0.48	7(4.19)	0.20	1.00
	碘盐与非碘盐相当	73	6(8.22)			3(4.11)
	非碘盐为主	141	6(4.26)			5(3.55)
海产品食用频率	> 3次/周	45	4(8.89)	1.19	0.56	2(4.44)	1.08	0.63
	> 1次/月且≤3次/周	249	16(6.43)			12(4.82)
	几乎不吃	91	4(4.40)			2(2.20)
每天睡眠时长/h	< 8	139	11(7.91)	0.99	0.32	6(4.32)	0.01	0.93
	≥8	243	13(5.35)			10(4.12)
每天运动时长/h	> 1	153	7(4.58)	1.41	0.53	5(3.27)	1.28	0.51
	0.5~1	181	14(7.73)			10(5.52)
	< 0.5	48	3(6.25)			1(2.08)
BMI	消瘦	9	1(11.11)	1.99	0.54	0	0.77	0.81
	正常	252	14(5.56)			11(4.37)
	超重	92	6(6.52)			3(3.26)
	肥胖	33	3(9.09)			2(6.06)
合计		386	24(6.22)			16(4.15)
注： ()内数字为检出率/%。

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表 3 不同水平TGAb和TPOAb分层下女生甲状腺功能指标水平比较[x (x 95%CI)]

Table 3. Comparison of thyroid function indexes in girls with different concentration TGAb and TPOAb stratification[x (x 95%CI)]

TPOAb	TGAb	人数	统计值	TSH/(mU·L^-1)	TT3/(nmol·L^-1)	TT4/(nmol·L^-1)	FT3/(pmol·L^-1)	FT4/(pmol·L^-1)
正常	正常	357		0.30(0.27~0.32)	0.26(0.25~0.28)	91.37(89.52~93.21)	0.68(0.67~0.70)	1.18(1.17~1.18)
	偏高	13		-0.21(-0.31~0.27)	0.26(0.18~0.33)	101.14(88.53~113.75)	0.67(0.59~0.74)	1.22(1.18~1.26)
			Z值	4.94	0.22	-1.94	0.59	-2.07
			P值	< 0.01	0.83	0.04	0.56	0.04
偏高	正常	5		0.26(0.23~0.49)	0.31(0.13~0.48)	83.2(54.38~112.02)	0.70(0.53~0.87)	1.14(1.02~1.26)
	偏高	11		0.37(0.16~0.58)	0.26(0.19~0.33)	93.01(83.69~102.33)	0.71(0.65~0.76)	1.18(1.14~1.23)
			Z值	-0.72	0.72	-1.07	-0.17	-1.01
			P值	0.48	0.49	0.31	0.87	0.33

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表 4 青春期女生甲状腺功能水平多因素Logistic回归分析(n=386)

Table 4. Multivariate Logistic regression models analysis the influence factors on thyroid function(n=386)

自变量	TSH/(mU·L^-1)		TT3/(nmol·L^-1)		TT4/(nmol·L^-1)		FT3/(pmol·L^-1)		FT4/(pmol·L^-1)
自变量	β值(β值95%CI)	P值	β值(β值95%CI)	P值	β值(β值95%CI)	P值	β值(β值95%CI)	P值	β值(β值95%CI)	P值
青春发育分期
青春前期	1.00		1.00		1.00		1.00		1.00
青春发动期	1.53(0.51~4.59)	0.45	1.02(0.53~1.96)	0.95	0.47(0.25~0.90)	0.02	0.78(0.39~1.55)	0.48	0.91(0.49~1.72)	0.78
青春后期	3.47(0.23~51.41)	0.36	0.69(0.37~1.27)	0.23	0.43(0.23~0.81)	0.01	0.58(0.30~1.10)	0.10	0.82(0.45~1.48)	0.51
家中二手烟暴露	1.20(0.78~1.84)	0.40	0.89(0.58~1.37)	0.59	0.92(0.60~1.42)	0.72	0.97(0.62~1.50)	0.88	1.00(0.66~1.53)	0.99
每天睡眠时长	1.34(0.86~2.08)	0.20	1.07(0.68~1.67)	0.77	0.81(0.52~1.27)	0.36	1.08(0.69~1.71)	0.73	1.09(0.71~1.70)	0.69
每天运动时长/h
< 0.5	1.00		1.00		1.00		1.00		1.00
0.5~1	0.65(0.32~1.30)	0.22	0.96(0.47~1.97)	0.92	0.60(0.30~1.22)	0.16	1.12(0.54~2.30)	0.77	2.45(1.18~5.07)	0.02
> 1	0.79(0.40~1.54)	0.49	0.99(0.49~1.98)	0.97	0.87(0.44~1.72)	0.68	1.01(0.50~2.03)	0.98	2.19(1.08~4.44)	0.03
UIC
中度碘缺乏	1.00		1.00		1.00		1.00		1.00
轻度碘缺乏	0.41(0.13~1.28)	0.12	1.00(0.32~3.13)	0.99	0.45(0.13~1.50)	0.19	1.28(0.40~4.06)	0.68	0.75(0.24~2.30)	0.61
碘适量	0.66(0.23~1.94)	0.46	1.33(0.46~3.84)	0.60	0.36(0.12~1.10)	0.07	1.46(0.50~4.29)	0.49	0.71(0.25~2.02)	0.52
碘超适量	0.37(0.12~1.15)	0.09	1.54(0.51~4.69)	0.45	0.31(0.10~1.01)	0.05	2.03(0.65~6.31)	0.22	0.77(0.26~2.31)	0.65
碘过量	0.37(0.11~1.21)	0.10	1.70(0.53~5.51)	0.37	0.32(0.09~1.10)	0.07	1.68(0.51~5.53)	0.39	0.82(0.26~2.61)	0.74
BMI
消瘦	1.00		1.00		1.00		1.00		1.00
正常	0.99(0.25~3.92)	0.99	4.78(0.94~24.17)	0.06	0.87(0.21~3.58)	0.84	1.43(0.36~5.71)	0.62	0.99(0.25~3.96)	0.99
超重	0.93(0.22~3.89)	0.92	3.12(0.58~16.62)	0.18	1.38(0.32~6.06)	0.67	1.00(0.23~4.25)	1.00	1.09(0.26~4.62)	0.90
肥胖	0.75(0.16~3.50)	0.72	9.08(1.52~54.07)	0.02	1.06(0.22~5.14)	0.95	2.08(0.43~10.04)	0.36	2.11(0.44~10.03)	0.35
注：模型调整了家庭人均月收入、父母文化程度、是否食用碘盐和海产品食用频率。

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