Correlations between levels of thyroid hormone-related indicators and the status of physical development of children aged 6 years old in Pudong New Area, Shanghai
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摘要:
目的 探索甲状腺激素相关指标血清促甲状腺激素(TSH)、总三碘甲状腺原氨酸(TT3)和总甲状腺素(TT4)与学龄儿童体格发育状况的关系，为学龄儿童的健康指导和临床干预提供依据。 方法 2020年10—11月，采用分层整群抽样方法抽取浦东新区13所小学2 088名一年级6岁新生进行血清甲状腺激素水平检测、体格检查和问卷调查。使用年龄别身高Z评分(HAZ)、年龄别体重Z评分(WAZ)和年龄别体质量指数(BMI)Z评分(BAZ)进行体格发育状况评价，分析甲状腺激素水平与体格发育状况的关系。 结果 浦东新区学龄儿童TSH、TT3和TT4的M(P25, P75)分别为3.09(2.27，3.87)μIU/mL、2.06(1.88，2.25)nmol/L和110.30(99.80，120.00)nmol/L，身高、体重、BMI、HAZ、WAZ和BAZ分别为(122.34±5.22)cm、(24.72±4.90)kg、(16.42±2.40)kg/m2、(0.64±0.94)(0.71±1.69)和(0.50±1.30)。不同TSH水平儿童BMI、WAZ和BAZ差异均有统计学意义(F值分别为3.61，3.39，3.18，P值均＜0.05)；不同TT3水平儿童身高、体重、BMI、HAZ、WAZ和BAZ差异均有统计学意义(F值分别为15.28，53.79，54.77，15.78，27.57，52.78，P值均＜0.01)。与正常组相比，TSH偏高与BAZ分级呈正相关[OR(95%CI)=1.27(1.03~1.57)]；TT3偏低与HAZ分级、WAZ分级、BAZ分级呈负相关[OR值(95%CI)分别为0.68(0.54~0.85)，0.61(0.49~0.76)，0.63(0.51~0.79)]；TT3偏高与WAZ分级、BAZ分级呈正相关[OR值(95%CI)分别为1.90(1.55~2.33)，1.89(1.54~2.33)]；TT4偏高与BAZ分级呈正相关[OR值(95%CI)=1.26(1.02~1.56)]。 结论 上海市浦东新区6岁儿童甲状腺激素相关指标与体格发育状况存在关联，维持正常甲状腺激素水平对儿童健康具有重要意义。 Abstract:Objective To explore the correlations among serum thyroid stimulating hormone (TSH), total triiodothyronne (TT3) and total thyroxine (TT4) and the status of physical development of school-age children in Pudong New Area, Shanghai, so as to provide a basis for health guidance and clinical intervention for school-age children. Methods From October to November 2020, stratified cluster sampling method was used to select 2 088 students aged 6 years old from 13 primary schools in Pudong New Area. Test of the level of serum thyroid hormone, physical examination and questionnaire investigation were performed. Height for age Z score (HAZ), Weight for age Z score (WAZ) and BMI for age Z score (BAZ) were used to evaluate child's status of physical development. The correlations among the level of thyroid hormone and the status of physical development of school-age children was analyzed. Results The median (P25, P75) values of TSH, TT3 and TT4 of school-age children in Pudong New Area were 3.09 (2.27, 3.87)μIU/mL, 2.06 (1.88, 2.25) nmol/L and 110.30 (99.80, 120.00) nmol/L. Height, weight, body mass index (BMI), HAZ, WAZ and BAZ were (122.34±5.22)cm, (24.72±4.90)kg, (16.42±2.40)kg/m2, (0.64±0.94) (0.71±1.69) and (0.50±1.30), respectively. There were statistically significant differences in BMI, WAZ and BAZ with different TSH levels (F=3.61, 3.39, 3.18, P < 0.05), and there were statistically significant differences in height, weight, BMI, HAZ, WAZ and BAZ (F=15.28, 53.79, 54.77, 15.78, 27.57, 52.78, P < 0.01) with different TT3 levels. Compared with the normal group, high TSH group was positively correlated with BAZ grading [OR(95%CI) =1.27 (1.03-1.57)], low TT3 group was negatively correlated with HAZ grading, WAZ grading, and BAZ grading [OR(95%CI) =0.68(0.54-0.85), 0.61(0.49-0.76), 0.63(0.51-0.79)], high TT3 group was positively correlated with WAZ grading and BAZ grading [OR(95%CI) =1.90(1.55-2.33), 1.89(1.54-2.33)], high TT4 group was positively correlated with BAZ grading [OR(95%CI)=1.26(1.02-1.56)] (P < 0.05). Conclusion The serum levels of thyroid hormone, Shanghai were correlated with physical development among 6-year-old Children in Pudong New Area, Shanghai. Keep normal thyroid hormone level is of great significance for children's health. -
Key words:
- Thyroid hormones /
- Growth and development /
- Regression analysis /
- Child
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表 1 不同组别学龄儿童甲状腺激素各指标水平比较[M(P25，P75)]
Table 1. Comparison of the index level of thyroid hormones for school-age children in different groups[M(P25, P75)]
组别 选项 人数 统计值 TSH/(μIU·mL-1) TT3/(nmol·L-1) TT4/(nmol·L-1) 性别 男 1 142 3.06(2.27，3.84) 2.06(1.90，2.30) 110.40(99.80，120.15) 女 946 3.13(2.27，3.90) 2.03(1.86，2.20) 110.10(99.78，119.50) Z值 -0.81 -4.43 -0.25 P值 0.42 ＜0.01 0.80 居住地 城区 732 2.99(2.21，3.85) 2.05(1.88，2.25) 108.80(98.93，118.48) 城郊 1 055 3.15(2.32，3.85) 2.09(1.89，2.27) 110.70(100.70，120.70) 乡村 301 3.14(2.21，4.01) 2.00(1.82，2.17) 111.20(100.40，120.10) H值 3.45 20.25 10.49 P值 0.18 ＜0.01 ＜0.01 
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表 2 不同组别学龄儿童体格发育指标比较(x±s)
Table 2. Comparison of physical development indexes of school-age children in different groups(x±s)
组别 选项 人数 统计值 身高/cm 体重/kg BMI/(kg·m-2) HAZ WAZ BAZ 性别 男 1 142 122.82±5.20 25.57±5.16 16.85±2.57 0.65±0.96 0.89±2.08 0.75±1.41 女 946 121.77±5.19 23.70±4.34 15.90±2.07 0.61±0.92 0.50±1.03 0.19±1.08 t值 4.57 8.83 9.19 0.96 5.18 10.10 P值 ＜0.01 ＜0.01 ＜0.01 0.34 ＜0.01 ＜0.01 居住地 城区 732 122.49±5.23 24.86±4.67 16.48±2.28 0.69±0.95 0.82±1.14 0.56±1.24 城郊 1 055 122.12±5.12 24.53±4.85 16.34±2.40 0.58±0.92 0.62±2.06 0.45±1.30 乡村 301 122.75±5.51 25.07±5.53 16.51±2.69 0.68±0.99 0.78±1.33 0.52±1.41 F值 2.21 1.90 0.96 3.34 2.98 1.59 P值 0.11 0.15 0.38 0.04 ＜0.05 0.21
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表 3 不同TSH、TT3及TT4水平儿童体格发育指标比较(x±s)
Table 3. Comparisons of physical development indexes in children with different TSH, TT3 and TT4 levels(x±s)
相关指标 选项 人数 统计值 身高/cm 体重/kg BMI/(kg·m-2) HAZ WAZ BAZ TSH 偏低组 521 122.26±5.29 24.38±4.44 16.23±2.18 0.60±0.96 0.56±2.64 0.41±1.20 正常组 1 046 122.38±5.12 24.72±5.01 16.40±2.47 0.65±0.92 0.74±1.23 0.48±1.35 偏高组 521 122.37±5.37 25.07±5.08 16.63±2.46 0.64±0.98 0.82±1.22 0.61±1.30 F值 0.10 2.59 3.61 0.40 3.39 3.18 P值 0.90 0.08 0.03 0.67 0.03 0.04 TT3 偏低组 542 121.48±5.12 23.42±4.05 15.80±1.98 0.47±0.91 0.41±1.05 0.16±1.15 正常组 1 029 122.35±5.17 24.55±4.60 16.31±2.24 0.64±0.94 0.66±2.05 0.45±1.21 偏高组 517 123.25±5.29 26.43±5.74 17.28±2.84 0.79±0.95 1.15±1.34 0.95±1.48 F值 15.28 53.79 54.77 15.78 27.57 52.78 P值 ＜0.01 ＜0.01 ＜0.01 ＜0.01 ＜0.01 ＜0.01 TT4 偏低组 520 122.34±5.04 24.80±4.78 16.49±2.40 0.63±0.91 0.77±1.17 0.55±1.30 正常组 1 053 122.37±5.20 24.60±2.88 16.33±2.45 0.65±0.94 0.66±2.06 0.44±1.29 偏高组 515 122.31±5.44 24.89±5.05 16.53±2.45 0.62±0.99 0.77±1.24 0.55±1.32 F值 0.02 0.73 1.52 0.12 1.10 1.95 P值 0.98 0.48 0.22 0.89 0.33 0.14
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表 4 6岁儿童TSH、TT3和TT4水平与体格发育状况的关系[OR值(95%CI), n=2 088]
Table 4. The correlations between levels of TSH, TT3 and TT4 and status of physical development of children aged 6 years old[OR(95%CI), n=2 088]
自变量 选项 HAZ WAZ BAZ TSH 偏低组 0.95(0.95~1.18) 0.89(0.72~1.10) 0.90(0.73~1.12) 正常组 1.00 1.00 1.00 偏高组 1.05(0.85~1.30) 1.18(0.96~1.45) 1.27(1.03~1.57)* TT3 偏低组 0.68(0.54~0.85)* 0.61(0.49~0.76)* 0.63(0.51~0.79)* 正常组 1.00 1.00 1.00 偏高组 1.22(0.98~1.51) 1.90(1.55~2.33)* 1.89(1.54~2.33)* TT4 偏低组 0.98(0.79~1.21) 1.06(0.87~1.31) 1.13(0.92~1.40) 正常组 1.00 1.00 1.00 偏高组 1.02(0.82~1.27) 1.23(0.99~1.51) 1.26(1.02~1.56)* 注：*P＜0.05。
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