代谢正常肥胖与甲状腺功能及甲状腺相关抗体的关系研究

目的了解代谢正常肥胖(metabolically healthy obese,MHO)人群甲状腺功能及甲状腺相关抗体水平特点,探讨其临床指导价值。方法筛查2018年1月至2018年12月于河北省沧州市中心医院体检中心体检人群共1570例,根据诊断及排除标准,共254例纳入研究,根据体重指数(body mass index,BMI)及有无代谢异常或代谢综合征(metabolic syndrome,MS)分为正常对照组(n=135)、MHO组(n=61)及肥胖伴MS组(n=58)。比较3组甲状腺功能及甲状腺相关抗体水平变化特点。结果MHO组FT4、TSH水平均高于正常对照组;肥胖伴MS组TSH水平高于MHO组,差异有统计学意义(P<0.05)。MHO组甲状腺球蛋白抗体(TGAb)及甲状腺过氧化物酶抗体(TPOAb)阳性率均高于正常对照组,差异有统计学意义(P<0.05);MHO组TGAb及TPOAb阳性率与肥胖伴MS组比较差异无统计学意义。结论MHO人群TSH、FT4水平升高,MS会导致TSH水平进一步升高;MHO人群需警惕有无自身免疫性甲状腺炎可能;对于TSH及TPOAb、TGAb升高的肥胖患者应积极排查有无代谢异常。

Study on the relationships of metabolically healthy obese with thyroid function and thyroid-related antibodies

Objective To understand the characteristics of thyroid function and thyroid-related antibodies in metabolically healthy obese(MHO)population,and investigate their clinical guidance value.Methods A total of 1570 people were screened in the Physical Examination Center of Cangzhou Central Hospital of Hebei Province from January 2018 to December 2018,according to the criteria of diagnosis and exclusion,254 patients were included in the study.According to body mass index(BMI)and metabolic abnormality or metabolic syndrome(MS),they were divided into normal control group(n=135),MHO group(n=61)and obesity combined with MS group(n=58).The changes of thyroid function and thyroid-related antibodies were analyzed and compared among three groups.Results The FT4 and TSH levels in the MHO group were higher than those of the normal control group,the level of TSH level in the obesity combined with MS group was higher than that in the MHO group,with statistical significant difference(P<0.05).The positive rates of thyroglobulin antibody(TGAb)and thyroid peroxidase antibody(TPOAb)in the MHO group were higher than those in the normal control group,with statistical significant difference(P<0.05).The positive rates of TGAb and TPOAb in MHO group were compared with those in obesity combined with MS group,with no statistical significant difference.Conclusion The level of TSH and FT4 in MHO population increases,and presents a further increase with the appearance of MS.MHO population should pay attention to the possibility of autoimmune thyroiditis.For obese patients with increased TSH,TPOAb and TGAb,metabolic abnormality should be actively screened.