摘要
目的分析健康体检人群血清游离三碘甲状腺原氨酸(FT3)/游离甲状腺素(FT4)比值与颈动脉硬化的相关性。方法本研究为回顾性横断面研究,连续选取2017年1月至2023年12月于中国医科大学附属盛京医院健康管理中心同时完成颈动脉超声和血清甲状腺素激素水平检测的4031例成年健康体检者,收集其一般资料、人体测量指标及相关实验室指标等。根据颈动脉超声结果分为颈动脉硬化组(2382例)和非颈动脉硬化组(1649例),按FT3/FT4比值中位数(0.35)分为FT3/FT4比值高组(1998例)、FT3/FT4比值低组(2033例)。采用受试者工作特征曲线分析血清FT3/FT4水平对颈动脉硬化的诊断价值。进而将颈动脉硬化组研究对象分为颈动脉中膜厚度(CIMT)增厚组(1006例),斑块形成组(1376例)。采用逐步逻辑回归分析评估FT3/FT4水平与颈动脉硬化不同严重程度的相关性。结果纳入研究的4031例健康体检者中,颈动脉硬化检出率为59.09%(2382/4031)。颈动脉硬化组FT3/FT4比值低于非颈动脉硬化组(0.34比0.39,Z=-19.958,P<0.001)。FT3/FT4比值高组颈动脉硬化发生率低于FT3/FT4比值低组(46.7%比71.3%,Z=251.797,P<0.001)。多因素回归显示,FT3/FT4比值是颈动脉硬化的独立保护因素(OR=0.493,95%CI:0.458~0.529),保护效应与高密度脂蛋白胆固醇(OR=0.659,95%CI:0.543~0.801)相当,而空腹血糖(OR=1.566)和低密度脂蛋白胆固醇(OR=1.164)为危险因素。ROC曲线分析显示,FT3/FT4比值诊断颈动脉硬化的AUC为0.685(灵敏度79.3%,特异度50.2%,截断值0.39)。在颈动脉硬化亚型分析中,斑块形成组FT3/FT4比值(0.328)低于CIMT增厚组(0.360)和非颈动脉硬化组(0.391,均P<0.001),且对斑块形成的保护效应更强(OR=0.297,95%CI:0.256~0.344)。结论FT3/FT4比值与颈动脉硬化严重程度呈剂量-效应关系,可作为心血管高风险人群的辅助筛查指标,需联合其他代谢指标优化诊断效能。
ObjectiveTo explore the correlation between the ratio of serum free triiodothyronine/free thyroxine(FT3/FT4)and carotid atherosclerosis in a population undergoing physical examination.MethodsThis retrospective cross-sectional study consecutively enrolled 4031 adult healthy examinees who underwent both carotid ultrasound and serum thyroid hormone level testing at the Health Management Center of Shengjing Hospital Affiliated to China Medical University from January 2017 to December 2023.The general information,anthropometric measurements,and related laboratory indicators were collected.Based on carotid ultrasound results,the participants were divided into carotid atherosclerosis group(2382 cases)and non-carotid atherosclerosis group(1649 cases).According to the median FT3/FT4 ratio(0.35),participants were further categorized into a high FT3/FT4 ratio group(1998 cases)and a low FT3/FT4 ratio group(2033 cases).Receiver operating characteristic(ROC)curve analysis was performed to assess the diagnostic value of serum FT3/FT4 levels for carotid atherosclerosis.Additionally,the carotid atherosclerosis group was subdivided into carotid intima-media thickness(CIMT)thickening group(1006 cases)and plaque formation group(1376 cases).Stepwise logistic regression analysis was used to assess the correlation between FT3/FT4 levels and different severity of carotid artery stiffness.ResultsAmong the 4031 health examinees included in the study,the detection rate of carotid atherosclerosis was 59.09%(2382/4031).The FT3/FT4 ratio in the carotid atherosclerosis group was significantly lower than that in the non-carotid atherosclerosis group(0.34 vs 0.39,Z=-19.958,P<0.001).The incidence rate of carotid atherosclerosis in the high FT3/FT4 ratio group was significantly lower than that in the low FT3/FT4 ratio group(46.7%vs 71.3%,Z=251.797,P<0.001).Multivariate regression analysis revealed that the FT3/FT4 ratio was an independent protective factor for carotid atherosclerosis(OR=0.493,95%CI:0.458-0.529),with a protective effect comparable to high-density lipoprotein cholesterol(OR=0.659,95%CI:0.543-0.801),while fasting blood glucose(OR=1.566)and low-density lipoprotein cholesterol(OR=1.164)were risk factors.ROC curve analysis showed that the area under the curve(AUC)of the FT3/FT4 ratio for diagnosing carotid atherosclerosis was 0.685(sensitivity 79.3%,specificity 50.2%,cutoff value 0.39).In the analysis of carotid atherosclerosis subtypes,the FT3/FT4 ratio in the plaque formation group(0.328)was significantly lower than that in the CIMT thickening group(0.360)and the non-stiffness group(0.391)(all P<0.001),and it exhibited a stronger protective effect against plaque formation(OR=0.297,95%CI:0.256-0.344).ConclusionThe FT3/FT4 ratio shows a dose-response relationship with the severity of carotid artery sclerosis and can serve as an auxiliary screening indicator for individuals at high cardiovascular risk.To enhance diagnostic efficacy,it is recommended to integrate this measure with other metabolic indicators.
作者
郭颖
张耐思
裴冬梅
Guo Ying;Zhang Naisi;Pei Dongmei(Health Management Centre,Shengjing Hospital,China Medical University,Shenyang 110023,China)
出处
《中华健康管理学杂志》
北大核心
2025年第7期493-499,共7页
Chinese Journal of Health Management
基金
辽宁省科学技术计划项目应用基础研究计划(联合计划)(2022020807-JH2/1015)。
