超重肥胖少儿血清促甲状腺激素水平研究

目的 探讨促甲状腺激素水平和儿童、青少年超重肥胖的关系,为临床干预及其治疗提供依据。方法 选取2016年4月-2017年4月期间在温州医科大学附属第二医院体检的385名3~18岁的儿童、青少年(对照183人、超重116人和肥胖86人)纳入本研究,比较其临床资料。结果 对照、超重、肥胖三组间血促甲状腺激素水平(TSH)浓度逐渐升高,谷丙转氨酶(ALT)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL)、尿酸(UA)、空腹胰岛素(Fins)、HOMA稳态模型(HOMA-IR、HOMA-β)均逐步增高(P<0.05)。且在超重肥胖人群中,有15.30%的儿童、青少年都出现了不同程度的甲状腺功能异常,根据TSH浓度分组后,高TSH组肥胖率显著升高(P<0.01)。随着TSH的升高,ALT、谷氨酰转肽酶(GGT)、TG呈升高趋势,高密度脂蛋白胆固醇(HDL)呈下降趋势(P<0.05)。经Logistic回归分析后,结果显示TSH并不独立影响儿童、青少年的超重肥胖。结论 在超重肥胖儿童、青少年人群中会出现如肝酶、血脂、尿酸升高等代谢异常,同时在肥胖少儿中都出现了不同程度的甲状腺功能异常,TSH的浓度都有不同程度的升高,且TSH升高可能是肥胖出现后产生的适应性改变。

Study on the thyroid stimulating hormone level in children and adolescents with overweight and obesity

Objective To analyze the correlation between thyroid stimulating hormone (TSH) and overweight and obese children and adolescents, in order to provide reference for clinical intervention and treatment. Methods Children and adolescents aged 3-18 years who took health examination in the Second Affiliated Hospital of Wenzhou Medical University from April 2016 to April 2017 were selected into the study. Totally 385 children were enrolled, including 183 controls,116 overweight children and 83 obese children. Clinical data and thyroid functions of three groups were compared and analyzed. Results The levels of TSH, alanine aminotransferase(ALT), triglyceride(TG), cholesterol(TC),low density lipoprotein(LDL), uric acid(UA), fasting insulin(Fins), HOMA index (HOMA-β, HOMA-IR) gradually increased among control, overweight and obesity groups (P<0.05). Different degrees of thyroid dysfunction were found in 15.30% of the children with overweight and obesity. The obesity rate was significantly higher in high TSH group (P<0.01). With the increasing of TSH concentration, the incidences of ALT, GGT, TG showed gradually ascending trends respectively, while HDL decreased on the contrary. Multivariate Logistics regression analysis showed that TSH might not be an independent risk factor of overweight and obesity in children and adolescents. Conclusions In the children and adolescents with overweight or obesity, there were some metabolic abnormalities such as increasing level of liver enzymes, hyperlipidaemia, hyperuricemia. Meanwhile, obesity group tends to develop thyroid dysfunction, with higher level of TSH. Moreover, the increasing of TSH level might be an adaptive change after obesity.