维生素D缺乏与桥本甲状腺炎及相关因素的研究

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,FT_3)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。

Study on the relationship between vitamin D deficiency and Hashimoto’s thyroiditis

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 Dodds 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.