甲状腺功能正常及亚临床甲状腺功能减退的老年人血清促甲状腺激素水平与认知障碍的相关性

doi:10.3969/j.issn.1003-9198.2024.05.013

摘要/Abstract

摘要： 目的探讨甲状腺功能正常及亚临床甲状腺功能减退(SCH)的老年人血清促甲状腺激素(thyroid-stimulating hormone,TSH)水平与认知障碍之间的关联。方法回顾性纳入2016年7月至2018年12月南京医科大学第一附属医院老年医学科行认知评估的262例甲状腺功能正常及30例亚临床甲状腺功能减退的老年人,收集其人口学和各项临床数据,使用MoCA量表评价其认知功能。采用限制性立方样条模型和多因素Logistic回归模型探讨血清TSH与认知障碍的相关性及剂量反应关系,并亚组分析多种因素对认知障碍的影响。结果认知障碍组(MoCA<26分,n=230)中SCH者30例,认知功能正常组(MoCA≥26分,n=62)中SCH者0例,2组SCH患病率差异有统计学意义(P<0.001),但2组TSH水平差异无统计学意义(P>0.05)。限制性立方样条分析结果显示,TSH与认知障碍发生风险的剂量反应关系呈现U型曲线关系(P=0.047)。将SCH病人作为SCH组,将TSH水平正常的老年人按TSH水平的三分位数分为正常低组(0.41~1.48 mIU/L)、正常中组(1.49~2.51 mIU/L)和正常高组(2.52~4.50 mIU/L),完全校正混杂因素后,与正常低组相比,正常高组和SCH组受试者的认知障碍OR值分别为0.37(95%CI:0.16~0.80)和7.72(95%CI:2.15~51.02)。亚组分析结果显示,在男性及年龄>75岁的受试者中,血清TSH水平与认知障碍发生风险呈显著负相关(P<0.05)。结论正常范围内血清TSH浓度的增加可能降低认知障碍风险,SCH是老年人认知障碍的独立危险因素。

关键词: 亚临床甲状腺功能减退症, 认知障碍, 老年人, 促甲状腺激素

Abstract: Objective To investigate the association between serum thyroid-stimulating hormone (TSH) level and cognitive impairment (CI) in the elderly with normal thyroid function or subclinical hypothyroidism (SCH). Methods A total of 292 elderly patients with normal thyroid function or SCH in Department of Geriatrics, Jiangsu Province Hospital from Jul 2016 to Dec 2018 were retrospectively enrolled in this study. Montreal Cognitive Assessment(MoCA)was used to measure the cognitive function. The demographic and clinical data were collected.The restricted cubic spline model and multivariate Logistic regression model were used to explore the correlation between serum TSH concentration and the risk of CI and the dose-response relationship, and subgroup analyses were performed to evaluate the influence of multiple factors on CI. Results The CI group (MoCA < 26, n=230) included 30 cases of SCH, while the non-CI group (MoCA ≥ 26, n=62) had no SCH case, showing a significant difference in SCH prevalence (P<0.001). No significant difference in TSH level were observed between the two groups (P>0.05).Restricted cubic spline showed that the dose-response relationship between TSH and the risk of CI was U-shaped (P=0.047).The SCH patients were set as the SCH group, and those with normal TSH level were divided into normal low group (0.41-1.48 mIU/L), normal middle group (1.49-2.51 mIU/L) and normal high group (2.52-4.50 mIU/L) according to tertile of TSH levels. After adjustment for all confounders, the odds ratios for CI were 0.37(95%CI: 0.16-0.80) and 7.72(95%CI: 2.15-51.02) for the normal high group and SCH group, respectively, compared with the normal low group.Subgroup analysis showed that the serum TSH level was significantly negatively associated with the risk of CI in male subjects and subjects aged 75 years and over (P<0.05). Conclusions Increased serum TSH levels within the normal range may reduce the risk of cognitive impairment. SCH is an independent risk factor for cognitive impairment in the elderly.

Key words: subclinical hypothyroidism, cognitive impairment, aged, thyroid-stimulating hormone

中图分类号:

隗倩, 蔡颖源, 王珊, 谈福云, 陆小伟. 甲状腺功能正常及亚临床甲状腺功能减退的老年人血清促甲状腺激素水平与认知障碍的相关性[J]. 实用老年医学, 2024, 38(5): 486-437.

WEI qian, CAI Yingyuan, WANG Shan,TAN Fuyun, LU Xiaowei. Relationship between serum thyrotropin and risk of cognitive impairment in elderly with normalthyroid function and subclinical hypothyroidism[J]. Practical Geriatrics, 2024, 38(5): 486-437.

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