维生素D缺乏与桥本甲状腺炎及相关因素的研究

doi:10.16138/j.1673-6087.2021.01.007

摘要/Abstract

摘要：

目的： 评估桥本甲状腺炎（Hashimoto’s thyroiditis,HT）及相关因素与25-羟维生素D的相关性。方法：选取2017年1月至2019年12月于我院内分泌科住院治疗的HT患者334例,同时选取同期非HT患者300例作为对照组,2组性别构成及年龄差异均无统计学意义（P>0.05）,分别收集2组患者的肝功能、肾功能、血糖、血脂、电解质水平,以及甲状腺功能、甲状腺抗体及维生素D水平等相关指标并进行分析。结果：2组患者的维生素D水平及维生素D缺乏率差异均无统计学意义（均P>0.05）,但促甲状腺素（thyroid stimulating hormone, TSH）水平及亚临床甲状腺功能减退（甲减）发生率,HT组均显著高于对照组（P<0.05）。女性HT患者的维生素D水平更低且更易出现亚临床甲减（P<0.05）。维生素D不足或缺乏的患者较维生素D正常的HT患者更易出现亚临床甲减（P<0.05）。血清游离三碘甲状腺原氨酸（free triiodothyronine,FT₃）是25-羟维生素D的保护因素[优势比（odds ratio,OR）=0.958,P=0.002],而血清TSH（OR=1.080,P=0.002）、女性（OR=1.167,P=0.001）均为25-羟维生素D的危险因素。结论：维生素D缺乏普遍存在于人群中,尤其女性群体更易出现维生素D缺乏,维生素D降低可导致HT患者TSH水平升高并增加亚临床甲减的发病率。

关键词: 桥本甲状腺炎, 维生素D, 促甲状腺激素, 免疫性疾病

Abstract:

Objective To evaluate the relationship between Hashimoto’s thyroiditis (HT) and 25-hydroxy vitamin D. Methods A total of 334 HT patients were enrolled from the endocrine department of our hospital from January 2017 to December 2019, and 300 non-HT patients were selected as the control. There was no significant difference in gender and age composition between the two groups(P>0.05). The indexes of liver function, renal function, blood glucose, blood lipid, electrolyte level, thyroid function, thyroid antibody and vitamin D level of the two groups were collected and analyzed. Results Compared with the control group, there was no significant difference in vitamin D level and vitamin D deficiency rate between the HT group and the control group (P>0.05), while the thyroid stimulating hormone (TSH) level and the incidence of subclinical hypothyroidism in the HT group was significantly higher than that in the control group(P<0.05). The vitamin D level of female HT patients was lower and the cases of subclinical hypothyroidism were more(P<0.05). The HT patients with vitamin D deficiency were more likely to show subclinical hypothyroidism than the HT patients with normal vitamin D. Serum free triiodothyronine(FT₃) was a protective factor for 25-hydroxy vitamin D[odds ratio(OR)=0.958, P=0.002], serum TSH(OR=1.080, P=0.002) and female(OR=1.167, P=0.001) were risk factors for 25-hydroxy vitamin D. Conclusions The vitamin D deficiency is prevalent in the population, especially in female. Vitamin D deficiency can lead to higher TSH level and increase the incidence of subclinical hypothyroidism in HT patients.

Key words: Hashimoto’s thyroiditis, Vitamin D, Thyroid stimulating hormone, Immune disease

中图分类号:

R581.4

付佳闻, 李晓华, 张宏利, 徐艳红, 朱祎. 维生素D缺乏与桥本甲状腺炎及相关因素的研究[J]. 内科理论与实践, 2021, 16(01): 27-31.

FU Jiawen, LI Xiaohua, ZHANG Hongli, XU Yanhong, ZHU Yi. Study on the relationship between vitamin D deficiency and Hashimoto’s thyroiditis[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(01): 27-31.

图/表 5

表1

表2

表3

表4

表5

参考文献 17

[1]	Ben-Zvi I, Aranow C, Mackay M, et al. The impact of vitamin D on dendritic cell function in patients with systemic lupus erythematosus[J]. PLoS One, 2010, 5(2): e9193. doi: 10.1371/journal.pone.0009193 URL
[2]	王国凤, 徐宽枫, 杨涛. 维生素D受体基因多态性与1型糖尿病易感性的Meta分析[J]. 中国糖尿病杂志, 2015, 15(2): 110-114.
[3]	尚敬, 于璐, 李全忠, 等. 桥本甲状腺炎甲状腺功能减退患者血清1,25-二羟维生素D₃及白细胞介素-8水平变化及意义[J]. 中华实用诊断与治疗杂志, 2018, 32(6): 575-577.
[4]	白桂荣, 时永强, 谢晓敏, 等. 桥本甲状腺炎患者甲状腺激素与血清25-羟维生素D水平的关系[J]. 宁夏医学杂志, 2016, 18(9): 815-816.
[5]	中华医学会内分泌学分会. 中国甲状腺疾病诊治指南--甲状腺炎[J]. 中华内科杂志, 2008, 47(9): 784-785.
[6]	中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症诊疗指南(2017)[J]. 中华骨质疏松和骨矿盐疾病杂志, 2017, 10(5): 413-443.
[7]	D’Aurizio F, Villalta D, Metus P, et al. Is vitamin D a player or not in the pathophysiology of autoimmune thyroid diseases[J]. Autoimmun Rev, 2015, 14(5): 363-369. doi: 10.1016/j.autrev.2014.10.008 URL
[8]	Caturegli P, Kimura H, Rocchi R, et al. Autoimmune thyroid diseases[J]. Curr Opin Rheumatol, 2007, 19(1): 44-48. pmid: 17143095
[9]	王卓然, 苏鑫洪, 贺晓生, 等. 关于维生素D与桥本甲状腺炎的研究进展[J]. 转化医学电子杂志, 2018, 5(5): 44-47.
[10]	Buckland J. Rheumatoid arthritis: control of T(H)17 cell activity in RA by a combination of vitamin D receptor signaling and TNF-blockade[J]. Nat Rev Rheumatol, 2012, 8(3): 124. doi: 10.1038/nrrheum.2012.3 pmid: 22270075
[11]	苟晓琴, 李勤, 李世云, 等. 成都市18-40岁室内工作健康女性维生素D营养状况分析[J]. 临床合理用药, 2014, 12(7): 28-29.
[12]	朱玲龑, 冉利梅, 聂四平, 等. 677例围绝经期女性维生素D3水平及其影响因素[J]. 贵州医科大学学报, 2016, 42(11): 3121-3126.
[13]	王平, 王建凤, 刘善新, 等. 桥本氏甲状腺炎发病机制及治疗方法研究进展[J]. 药学研究, 2015, 34(10): 599-603.
[14]	袁帅, 江璐, 朱力, 等. 上海地区6112例健康体检者血清甲状腺激素和甲状腺自身抗体检测结果分析[J]. 检验医学, 2015, 30(3): 219-223.
[15]	Trnquist K, Forss L, Lamberg-Allardt C. Effects of vitamin D₃ metabolites on thyrotropin secretion from rat pituitary cells in culture[J]. J Endocrinol Invest, 1990, 13(5): 391-395. doi: 10.1007/BF03350686 URL
[16]	贾瑞红. 骨化三醇联合左甲状腺素钠片治疗桥本甲状腺炎伴甲状腺功能减退症疗效观察[J]. 医药论坛杂志, 2020, 41(2): 133-135.
[17]	Chahardoli R, Saboor-Yaraghi AA, Amouzegar A, et al. Can supplementation with vitamin D modify thyroid autoantibodies (anti-TPO Ab, anti-Tg Ab) and thyroid profile (T₃, T₄, TSH) in Hashimoto’s thyroiditis[J]. Horm Metab Res, 2019, 51(5): 296-301. doi: 10.1055/a-0856-1044 pmid: 31071734

项目	对照组（n=300）	HT组（n=334）
性别（男/女）	122/178	129/205
年龄(岁)	61.39±12.00	63.10±11.49
ALT(U/L)	22.25(14.70,29.78)	23.40(14.33,30.28)
AST(U/L)	20.70(16.10,27.70)	20.57(16.23,27.18)
肌酐(μmol/L)	59.90(48.52,73.50)	61.20(49.94,72.18)
尿素氮(mmol/L)	5.77±1.70	5.79±1.90
三酰甘油(mmol/L)	1.55(1.00,2.31)	1.59(1.01,2.32)
总胆固醇(mmol/L)	4.49±1.12	4.53±1.11
空腹葡萄糖(mmol/L)	7.18(5.60,9.06)	7.23(5.66,8.80)
糖化血红蛋白(%)	7.61±1.12	7.80±1.25
钙(mmol/L)	2.34±0.12	2.32±0.15
磷(mmol/L)	1.23±0.27	1.21±0.30
PTH(pmol/L)	4.95±1.80	4.80±1.66

项目	对照组（n=300）	HT组（n=334）
FT₃(nmol/L)	4.81±0.60	4.72±0.63
FT₄(pmol/L)	11.34±1.64	11.34±1.80
TGAb(kU/L)	0.00(0.00,0.01)	7.15(0.30,60.65)¹⁾
TPOAb(kU/L)	0.70(0.40,1.50)	34.85(9.55,232.68)¹⁾
TSH(mU/L)	2.04(1.42,3.05)	2.64(1.69,3.96)¹⁾
亚临床甲减[n(%)]	6(2.0)	42（12.6）¹⁾
25-羟维生素D (pmol/L)	16.66(11.98,22.13)	16.84(11.81,23.39)
维生素D缺乏[n(%)]	209(69.7)	214(64.1)

项目	男性(n=129)	女性（n=205）
FT₃(nmol/L)	4.80±0.67	4.67±0.60
FT₄(pmol/L)	11.23±1.84	11.41±1.77
TSH(mU/L)	2.27(1.33,3.52)	2.87(1.92,4.48)¹⁾
亚临床甲减[n(%)]	11(8.5)	31(15.1)¹⁾
TGAb(kU/L)	6.90(0.10,57.10)	8.30(0.70,58.80)
TPOAb(kU/L)	32.40(11.25,235.15)	36.90(3.90,232.00)
25-羟维生素D (pmol/L)	18.62(14.41,24.48)	15.75(10.73,22.77)¹⁾
维生素D缺乏[n(%)]	75(58.1)	139(67.8)¹⁾

项目	维生素D 正常组(n=30)	维生素D 不足组(n=90)	维生素D 缺乏组(n=214)
TSH(mU/L)	2.35(1.49,3.65)	2.63(1.61,4.09)¹⁾	2.78(1.70,4.20)¹⁾
亚临床甲减	2(6.7)	9(10.0)¹⁾	31(14.5)¹⁾

模型	非标准化系数		标准系数			95%置信区间
模型	B	标准误	β	t	P	95%置信区间
(常量)	7.635	2.455		3.110	0.002	2.814~12.456
FT₃	1.520	0.496	0.121	3.065	0.002	0.546~2.494
性别	-2.062	0.621	-0.131	-3.320	0.001	-0.842~-2.494
TSH	-0.720	0.054	-0.081	-2.575	0.002	-0.723~-0.210