正文:注:*P<0.05
2.3 TSH水平相关性分析
经多元线性回归分析,最后有年龄(β=0.060,P=0.000)、BMI(β=0.148,P=0.009)、TG(β=0.246,P=0.031)和LDL(β=0.509,P=0.002)进入模型。在修正年龄因素后,TSH与TG(r=0.131,P=0.033)、LDL(r=0.123,P=0.044)仍然相关。
3 讨论
亚临床甲状腺功能减退是目前从诊断标准到治疗方案都存在颇多争议的一种疾病。由于观察到亚甲减导致孕妇妊娠期并发症增加,并可对胎儿的智力和身体发育造成影响[4],因而在妊娠期女性的治疗相对更积极。但考虑到治疗可能出现的医源性甲亢、骨质疏松等副作用,非妊娠期的亚甲减是否需要治疗还存在争议[5]。现在较一致的观点是在亚甲减病人中,TSH>10mU/L时使用L-T4治疗,TSH在正常上限到10mU/L之间不进行替代治疗,但需定期观察。但TSH升高对机体的不利改变可能早已发生,有结果表明促甲状腺素在正常的范围内,血脂也会随TSH的升高而改变[6],在正常范围内以2.5mU/L做为TSH的分界值,同样观察到两组的血脂谱有显著差异[7]。因此有人建议TSH的目标值应降低至3mU/L以下。目前看来TSH的功能远不止局限在对TH的调节上,其他潜在的生理调节机制还有待进一步明确。因此将来围绕亚甲减人群在代谢各方面的研究还有待完善。进行甲状腺功能检查对有甲状腺器质性病变的人群很有必要,尤其是对合并有高血脂的老年人意义更大。
参考文献
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