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肥胖、超重对学龄儿童与青少年甲状腺功能及结构的影响

Overweight and Obese Affects Thyroid Function and Structure in School-age Children and Adolescents

作者: 专业:内科学 导师:刘超 年度:2010 学位:硕士  院校: 南京医科大学

Keywords

obesity, overweight, thyroid function, thyroid volume, thyroid nodule

        目的:研究肥胖、超重对学龄儿童与青少年甲状腺功能及结构的影响。方法:采用分层整群抽样方法对安徽蚌埠市四个区7-18岁学龄儿童与青少年进行超重与肥胖的流行病学调查,根据身高和体重筛查结果募集了超重、肥胖及正常人群共959名,收集到有效样本781名,包括肥胖组327人,超重组242人及正常组212人,测量血压、腰围、腹围等身体指标,空腹抽血测血清促甲状腺素(TSH)、血清游离三碘甲腺游氨酸(FT3)、游离甲状腺素(FT4)和甲状腺过氧化物酶抗体(TPOAb),同时进行甲状腺B超检查。结果:(1)BMI和腰围均与TSH和FT3呈正相关,与FT4呈负相关,在调整了年龄、性别等相关因素后,关联仍有统计学意义;肥胖、超重会引起学龄儿童及青少年甲状腺功能的变化,表现为TSH和FT3的上升及FT4的下降。(2)BMI和腰围(WC)与甲状腺体积呈显著正相关(rBMI=0.514,rWC=0.454),在调整了年龄、性别等因素后,其正相关性仍有统计学意义;肥胖、超重组甲状腺结节的检出率均高于正常对照组。(3)被调查的569名肥胖及超重学龄儿童与青少年中,仅有3人(A组)TPOAb阳性同时超声检查支持桥本甲状腺炎;6人(B组)TPOAb阳性但超声检查正常;74人(C组)TPOAb阴性但超声检查提示桥本甲状腺炎样低回声改变,其余486人(D组)TPOAb及超声均正常。其中,A组和D组TSH水平高于正常对照组(P<0.05),C组和D组的FT3水平高于正常对照组(P<0.05)。结论:肥胖、超重会对学龄儿童及青少年甲状腺功能产生影响。此外,超重及肥胖还会导致学龄儿童及青少年甲状腺体积增加及甲状腺结节的检出率增加。肥胖对甲状腺功能的影响并不能完全归因于自身免疫性甲状腺炎,肥胖状态所致下丘脑-垂体-甲状腺轴的损伤及肥胖导致的低度炎症状态有可能参与其中。
    Objective: To investigate the effects of overweight and obese on thyroid function and structure in school-age children and adolescents.Methods: A cross-sectional survey with stratified cluster sampling was conducted in four districts in Bengbu city, Anhui province, 959 subjects aged 7-18 were recruited from subgroups of overwight, obese and nomal weight which were screened by body mass index (BMI). 781 of the subjects, included 327 obese, 242 overweight and 212 normal body weight, were brought into the study and futher accepted blood pressure, waist circumference and abdominal circumference measurement. Blood samples were collected in fasting status to test thyroid stimulating hormone (TSH), serum free triiodothyronine (FT3), free thyroxin (FT4), thyroid peroxidase antibodies (TPOAb) and thyroid ultrasound.Results: (1) FT3 and TSH were both positively correlated with BMI and waist circumference, while FT4 was negatively associated with them, even after adjustment for age and sex. Overweight and obesity significantly affected thyroid function for children through elevated TSH and FT3 and decreased FT4. (2) BMI and waist circumference (WC) were positively correlated with thyroid volume (rBMI=0.514, rWC =0.454, respectively) even after adjustment for age and sex. The positive rate of thyroid nodule was slightly higher in the obese and overweight cases than normal subjects. (3) Of all 569 overweight and obese children and adolescents, only 3 children showed detectable antithyroid antibodies and an ultrasound pattern suggestive of Hashimoto’s thyroiditis (HT) (group A) and 6 showed detectable antithyroid antibodies with normal ultrasound finding (group B). A total of 74 subjects showed absent antithyroid antibodies with an ultrasound pattern suggestive of HT (group C), while 486 children and adolescents showed no thyroid antibodies with normal ultrasound finding (group D). TSH levels was higher in groups A and D compared with controls (P<0.05), whereas FT3 was higher in group C and D than in normal subjects (P<0.05).Conclusions: Our results suggest that thyroid function could be affected in obese and overweight children and adolescents. In additon, thyroid volume is increased and the detection rate of thyroid nodules is higher in obese and overweight than normal controls. Alterations of thyroid structure and function couldn’t be completely explained by the presence of an autoimmune involvement. The impairment of hypothalamic-pituitary-thyroid axis and the low grade inflammation may be involved in the change of thyroid function and structure.
        

肥胖、超重对学龄儿童与青少年甲状腺功能及结构的影响

英文缩写与注释4-5
第一部分:肥胖、超重对学龄儿童与青少年甲状腺功能及结构的影响5-28
    中文摘要5-7
    Abstract7-8
    引言9-11
    对象与方法11-15
    结果15-20
    讨论20-24
    参考文献24-28
第二部分:学龄儿童与青少年甲状腺功能和血压关系的研究28-45
    中文摘要28-29
    Abstract29-31
    引言31-33
    对象与方法33-36
    结果36-39
    讨论39-42
    参考文献42-45
结论与展望45-46
文献综述46-67
    肥胖与甲状腺疾病之关系的研究进展46-54
        一、肥胖与甲状腺功能状态47-49
        二、肥胖与结节性甲状腺肿49
        三、肥胖与亚临床甲状腺疾病49-50
        四、结语50
        参考文献50-54
    二甲双胍对甲状腺功能的影响54-61
        一、引言55
        二、二甲双胍对甲状腺功能影响的临床研究55-57
        三、二甲双胍对甲状腺功能影响的可能机制57-58
        四、.总结58
        参考文献58-61
    272例肾上腺肿瘤回顾分析61-67
        资料与方法62
        结果62-64
        讨论64-66
        参考文献66-67
附录67-72
攻读学位期间发表的论文和综述72-73
致谢73-74
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