上海市闵行区学龄女生甲状腺功能变化与青春期发育的队列研究

何丹丹; 黎锦鸿; 许慧琳; 王莹莹; 温晓飒; 付晔; 汤红梅; 苏华林; 徐东丽; 王娜

doi:10.16835/j.cnki.1000-9817.2023.07.020

上海市闵行区学龄女生甲状腺功能变化与青春期发育的队列研究

doi: 10.16835/j.cnki.1000-9817.2023.07.020

何丹丹^{1, 2},
黎锦鸿^{1, 2},
许慧琳^{1, 2},
王莹莹³,
温晓飒^{1, 2},
付晔^{1, 2},
汤红梅^{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综合防制办公室, 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:

上海市闵行区自然科学研究课题 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, 主任医师, 主要从事流行病学方面工作

通讯作者:
徐东丽, E-mail: 18918168689@163.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R322.5⁺¹ R179 R446.6
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- 被引次数: 0
出版历程
- 收稿日期: 2023-01-03
- 修回日期: 2023-05-19
- 网络出版日期: 2023-07-25
- 刊出日期: 2023-07-25

A longitudinal study on association between puberty development and thyroid function of school-aged girls in Minhang District, Shanghai

HE Dandan^{1, 2},
LI Jinhong^{1, 2},
XU Huilin^{1, 2},
WANG Yingying³,
WEN Xiaosa^{1, 2},
FU Ye^{1, 2},
TANG Hongmei^{1, 2},
SU Hualin^{1, 2},
XU Dongli^{1, 2
, ,},
WANG Na³

1.
Office of Integrated Control, Center for Disease Control and Prevention of Minhang District, Shanghai(201101), China

摘要

摘要: 目的了解上海市闵行区学龄女生甲状腺功能变化与青春期发育的相关性, 探讨青春发育对甲状腺功能的影响。方法基于闵行区碘适宜地区建立的青春期女生队列人群, 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, 最终将新入学的预初女生共464名纳入队列研究进行体格检查, 并在2021年1-3月进行随访。采用青春期发育量表(PDS)评价研究对象青春期发育分期, 测定每个参与者的血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)及游离甲状腺素(FT4), 并计算甲状腺稳态结构参数(THSPs)。采用Wilcoxon符号秩和检验比较基线和随访时甲状腺激素的变化, 采用多元线性回归分析甲状腺激素(THs)和THSPs变化与青春期发育的相关性。结果研究期间, 女生血清TSH水平降低, FT3和FT4水平升高(Z值分别为-10.53, -4.71, -12.46, P值均 < 0.01)。多元线性回归分析结果显示, 校正基线年龄、体质量指数(BMI)变化和腰围变化后, 高青春期分类得分变化组的FT4和甲状腺反馈分位数指数(TFQI)相比低青春期分类得分变化组进一步降低(β值分别为-0.66, -0.55);与基线和随访时均为青春期晚期(BLFL)组相比, 基线时为青春期前期、随访时为青春期晚期(BPFL)组+基线时为青春期前期、随访时为青春期结束(BPFT)组的FT4和TFQI下降幅度更大(β值分别为-0.55, -0.44)(P值均 < 0.05)。未发现△TSH、△FT3、△FT4/FT3和△TSHI与青春期分类得分变化或青春期发育模式的关联。结论青春期女生血清TSH降低, FT3和FT4升高。青春期发育模式和发育速度可能与甲状腺激素的变化有相关性。
- 甲状腺 /
- 青春期发育 /
- 生长和发育 /
- 队列研究 /
- 回归分析 /
- 学生 /
- 女(雌)性
Abstract: Objective To observe the association between puberty development and thyroid function among school-aged girls in Minhang District of Shanghai, in order to explore the effect of puberty development on thyroid function. Methods The study was based on a cohort of adolescent girls recruited in iodine-suitable areas of Minhang District, and the baseline and follow-up survey have been carried out from January to March 2019.The method of phased cluster sampling was used to select one junior high school in the east, south, north and middle of Minhang District, Shanghai, respectively.Finally, 464 new junior high school girls were included in the Cohort study for physical examination, and girls were followed up from January to March 2021.The Puberty Development Scale (PDS) was used to assess the stage of puberty.Serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were determined for each participant.Thyroid homeostasis structure parameters (THSPs) was calculated.Changes of Thyroid hormones at baseline and follow-up were compared by Wilcoxon signed rank sum test.Multiple linear regression analyses were used to evaluate the associations of thyroid hormones (THs) and THSPs changes with pubertal develepment. Results Serum TSH levels of female studentds decreased significantly, while their FT3 and FT4 levels increased significantly during the study period (Z=-10.53, -4.71, -12.46, P < 0.01).In multiple linear regression analysis after adjustment for co-variables (including baseline age, change of BMI and waist circumference), FT4 and thyroid feedback quantile-based index (TFQI) in the higher puberty category scores changes (△PCS) group were further reduced compared with those in the low △PCS group (β=-0.66, -0.55).Compared to the late puberty at baseline and follow-up (BLFL) group, FT4 and TFQI showed higher decline in the pre-puberty at baseline and late puberty at follow-up (BPFL) group with the pre-puberty at baseline and end of puberty at follow-up (BPFT) group (β=-0.55, -0.44)(P < 0.05).There were no association of △TSH, △FT3, △FT4/FT3 and TSH index changes (△TSHI) with △PCS or the puberty pattern. Conclusion Serum TSH decreases while serum FT3 and FT4 increase among girls during puberty.Both the initial stage and the velocity of pubertal development are related to thyroid hormone fluctuations.
- Thyroid gland /
- Adolescent development /
- Growth and development /
- Cohort studies /
- Regression analysis /
- Students /
- Female
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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表 1 不同PCS变化女生的基本特征、甲状腺激素和甲状腺稳态结构参数比较[M(P₂₅, P₇₅)]

Table 1. Characteristics, anthropometric indexes, THs and THSPs of girls with different PCS changes[M(P₂₅, P₇₅)]

时间	△PCS	人数	统计值	BMI/(kg·m^-2)^*	腰围/cm^*	TSH/(mU·L^-1)	FT3/(pmol·L^-1)
随访	低	228		21.02±3.74	69.94±8.89	1.63(1.17, 2.11)	5.57(5.22, 5.95)
	中	128		20.48±2.96	69.19±7.23	1.52(1.10, 2.04)	5.54(5.23, 6.07)
	高	108		20.56±3.32	69.15±7.79	1.80(1.24, 2.35)	5.57(5.20, 5.94)
			F/H值	1.25	0.50	6.92	0.13
			P值	0.29	0.61	0.03	0.94
基线	低	228		19.37±3.52	65.54±8.36	1.98(1.48, 2.78)	5.33(3.84, 5.83)
	中	128		18.83±3.30	63.18±6.09	1.90(1.35, 2.90)	5.69(4.28, 6.11)
	高	108		18.57±2.94	63.81±7.97	2.16(1.58, 3.03)	5.63(4.83, 6.03)
			F/H值	2.46	4.41	2.18	12.64
			P值	0.09	0.01	0.34	< 0.01

时间	△PCS	人数	统计值	FT4/(pmol·L^-1)	FT4/FT3	TSHI	TFQI
随访	低	228		16.55(15.43, 18.18)	3.02(2.81, 3.30)	2.72(2.36, 3.11)	-1.00(-1.56, -0.18)
	中	128		16.51(15.46, 17.83)	3.00(2.75, 3.31)	2.61(2.25, 2.98)	-1.02(-1.55, -0.36)
	高	108		16.44(14.94, 17.73)	2.94(2.73, 3.29)	2.76(2.44, 3.13)	-1.06(-1.81, -0.41)
			F/H值	2.32	1.91	5.10	2.32
			P值	0.31	0.39	0.08	0.31
基线	低	228		14.64(12.87, 16.35)	2.87(2.44, 3.89)	2.68(2.41, 2.99)	-0.79(-1.48, 0.16)
	中	128		14.13(12.41, 16.06)	2.68(2.27, 3.45)	2.55(2.21, 3.04)	-1.08(-1.79, 0.09)
	高	108		14.43(13.12, 16.20)	2.70(2.41, 3.36)	2.82(2.40, 3.18)	-0.46(-1.42, 0.65)
			F/H值	4.06	7.78	6.92	6.49
			P值	0.13	0.02	0.03	0.04
注： *为(x ±s)。

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表 2 不同青春期发育模式女生的基本特征、甲状腺激素和甲状腺稳态结构参数比较[M(P₂₅, P₇₅)]

Table 2. Characteristics, anthropometric indexes, THs, and THSPs of girls with different puberty patterns[M(P₂₅, P₇₅)]

时间	青春期发育模式	人数	统计值	BMI/ (kg·m^-2)^*	腰围/cm^*	TSH/(mU·L^-1)	FT3/(pmol·L^-1)	FT4/(pmol·L^-1)	FT4/FT3	TSHI	TFQI
随访	BPFP	21		17.75±2.28	63.08±6.78	1.68(1.16, 2.18)	5.73(5.35, 6.05)	16.25(14.94, 17.73)	2.97(2.59, 3.21)	2.60(2.20, 3.08)	-1.15(-1.81, -0.41)
	BPFL+BPFT	214		19.92±2.95	67.88±7.24	1.70(1.23, 2.32)	5.64(5.26, 6.02)	16.30(15.28, 17.67)	2.92(2.68, 3.22)	2.73(2.35, 3.05)	-1.13(-1.64, -0.44)
	BLFL	202		21.58±3.49	71.39±8.60	1.59(1.17, 2.05)	5.51(5.15, 5.94)	16.77(15.48, 18.29)	3.09(2.87, 3.36)	2.75(2.38, 3.11)	-0.89(-1.54, -0.13)
	BLFT+BTFT	27		23.63±3.89	74.07±7.59	1.35(0.91, 1.70)	5.69(5.29, 5.84)	16.44(14.92, 17.78)	2.98(2.68, 3.27)	2.57(1.98, 2.89)	-1.06(-1.82, -0.39)
			F/H值	22.25	14.65	8.38	5.15	8.49	17.55	5.91	8.49
			P值	< 0.01	< 0.01	0.04	0.16	0.03	< 0.01	0.12	0.04
基线	BPFP	21		16.22±1.86	58.93±5.01	2.33(1.56, 3.10)	5.66(4.94, 6.16)	13.47(12.59, 15.82)	2.48(2.21, 3.04)	2.67(2.41, 3.02)	-0.97(-1.61, -0.01)
	BPFL+BPFT	214		18.07±2.81	62.36±6.77	2.03(1.43, 3.03)	5.67(4.79, 6.05)	14.45(12.65, 16.10)	2.68(2.33, 3.41)	2.71(2.33, 3.12)	-0.76(-1.58, 0.53)
	BLFL	202		20.02±3.50	66.69±8.04	1.95(1.48, 2.76)	5.22(3.74, 5.82)	14.61(12.84, 16.29)	2.89(2.48, 4.01)	2.67(2.38, 2.99)	-0.79(-1.49, 0.11)
	BLFT+BTFT	27		21.58±2.92	69.16±7.43	1.90(1.11, 2.76)	5.55(4.40, 6.05)	14.56(12.97, 16.85)	2.87(2.56, 3.27)	2.72(2.32, 3.18)	-0.74(-1.98, 0.57)
			F/H值	25.48	19.77	1.74	20.93	2.07	15.71	0.49	0.65
			P值	< 0.01	< 0.01	0.63	< 0.01	0.56	< 0.01	0.92	0.88
注： *为(x ±s)。

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表 3 464名女生基线和随访基本特征和甲状腺激素比较

Table 3. Comparison of characteristics and thyroid hormone at baseline and follow-up in 464 girls

时间	BMI/(kg·m^-2)	腰围/cm	TSH/(mU·L^-1)	FT3/(pmol·L^-1)	FT4/(pmol·L^-1)
基线	19.04±3.34	64.49±7.76	2.02(1.47, 2.88)	5.48(4.06, 6.01)	14.48(12.80, 16.28)
随访	20.76±3.45	69.55±8.20	1.61(1.18, 2.15)	5.57(5.23, 5.97)	16.53(15.33, 17.97)
Z值	-16.06	-13.35	-10.53	-4.71	-12.46
P值	＜0.01	＜0.01	＜0.01	＜0.01	＜0.01

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表 4 464名女生不同青春期发育情况对甲状腺激素影响的多重线性回归分析[β值(95%CI)]

Table 4. Multiple liner regression analyses for changes in THs (△THs) according to puberty development in 464 girls[β(95%CI)]

自变量	选项	△TSH/(mU·L^-1)		△FT3/(pmol·L^-1)		△FT4/(pmol·L^-1)
自变量	选项	模型1	模型2	模型1	模型2	模型1	模型2
△PCS	低	1.00	1.00	1.00	1.00	1.00	1.00
	中	-0.16(-0.39~0.07)	-0.21(-0.44~0.02)	-0.22(-0.49~0.04)	-0.16(-0.42~0.10)	0.12(-0.48~0.72)	0.07(-0.53~0.67)
	高	-0.07(-0.11~0.05)	-0.12(-0.37~0.12)	-0.31(-0.58~-0.03)^*	-0.24(-0.52~0.04)	-0.67(-1.30~-0.04)^*	-0.66(-1.29~-0.02)^*
青春期发育模式	BPFP	-0.15(-0.62~0.38)	-0.27(-0.75~0.21)	-0.29(-0.84~0.25)^*	-0.13(-0.67~0.42)	0.04(-1.20~1.28)	-0.02(-1.28~1.23)
	BPFL+BPFT	-0.02(-0.22~0.18)	-0.10(-0.31~0.11)	-0.29(-0.52~-0.06)	-0.19(-0.43~0.05)	-0.54(-1.07~-0.01)^*	-0.55(-1.10~-0.01)^*
	BLFL	1.00	1.00	1.00	1.00	1.00	1.00
	BLFT+BTFT	-0.19(-0.61~0.23)	-0.18(-0.60~0.24)	-0.26(-0.74~0.23)	-0.28(-0.76~0.20)	-0.90(-2.00~0.21)	-0.82(-1.93~0.27)
注：模型1为调整协变量前的多重线性回归模型；模型2为调整协变量(基线年龄、BMI变化和腰围变化)后的多重线性回归模型；*P < 0.05。

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表 5 464名女生不同青春期发育情况对甲状腺结构态参数影响的多重线性回归分析[β值(95%CI)]

Table 5. Multiple liner regression analyses for changes in THSPs (△THSPs) according to puberty development in 464 girls[β(95%CI)]

自变量	选项	△FT4/FT3		△TSHI		△TFQI
自变量	选项	模型1	模型2	模型1	模型2	模型1	模型2
△PCS	低	1.00	1.00	1.00	1.00	1.00	1.00
	中	0.17(-0.03~0.36)	0.12(-0.08~0.31)	-0.03(-0.15~0.09)	-0.06(-0.18~0.06)	-0.02(-0.37~0.34)	-0.06(-0.42~0.30)
	高	0.10(-0.11~0.31)	0.06(-0.15~0.26)	-0.01(-0.14~0.12)	-0.04(-0.17~0.09)	-0.54(-0.91~-0.16)^*	-0.55(-0.92~-0.17)^*
青春期发育模式	BPFP	0.19(-0.22~0.61)	0.08(-0.33~0.49)	0.03(-0.22~0.29)	-0.01(-0.27~0.24)	-0.15(-0.89~0.58)	-0.28(-1.02~0.47)
	BPFL+BPFT	0.11(-0.07~0.29)	0.04(-0.14~0.22)	-0.02(-0.13~0.09)	-0.06(-0.17~0.06)	-0.39(-0.71~-0.07)^*	-0.44(-0.76~-0.11)^*
	BLFL	1.00	1.00	1.00	1.00	1.00	1.00
	BLFT+BTFT	0.04(-0.33~0.41)	0.07(-0.30~0.43)	-0.21(-0.43~0.02)	-0.20(-0.42~0.03)	-0.24(-0.90~0.42)	-0.18(-0.83~0.48)
注：模型1为调整协变量前的多重线性回归模型；模型2为调整协变量(基线年龄、BMI变化和腰围变化)后的多重线性回归模型；*P < 0.05。

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