【作者】 毛玉山；

【导师】 刘志民； 石勇铨； 邹俊杰；

【作者基本信息】 第二军医大学 ， 内科学， 2010， 博士

【摘要】 目的调查宁波市某石油化工企业全体在职和退休员工甲状腺功能异常的患病现况。方法采用普查方法,调查了该企业10461名员工的甲状腺疾病史和甲状腺功能状况。结果在该石化员工人群中,各种甲状腺功能异常的总患病率为4.62%,标化患病率2.95%；男性和女性的患病率分别2.70%和9.11%,标化患病率相应为2.06%和5.31%。该人群对甲状腺疾病的知晓率为1.81%,男性0.86%,女性4.09%；已知晓有甲状腺疾病史者中,高达25%的人甲状腺功能依然未能正常。否认有甲状腺疾病史者中,甲状腺功能异常的患病率为2.87%,男性1.88%,女性5.29%。亚临床甲状腺功能减退症占新发现甲状腺功能异常者的81.7%,70岁以上老年人患病率高于其它年龄段者。结论宁波市某石化企业员工甲状腺功能异常患病率超过4.5%,以亚临床甲状腺功能减退症最为多见,患病率随年龄增长而升高,女性患病率高于男性。目的调查宁波市某石油化工企业全体老年退休员工甲状腺功能异常的患病现况。方法采用普查方法,调查了该企业1759名60岁以上退休员工的甲状腺疾病史和甲状腺功能状况。结果在该老年人群中,已知甲状腺疾病的患病率为3.9%,女性7.6%,男性1.9%；否认有甲状腺疾病史者中,甲状腺功能异常的患病率为4.7%,女性6.9%,男性3.5%；该老年人群已知与新发现甲状腺功能异常的总患病率达8.5%,女性14.0%,男性5.4%。亚临床甲状腺功能减退症占新发现甲状腺功能异常者的81.0%。老年人甲状腺功能异常患病率显著高于非老年人。结论宁波市老年石化退休员工甲状腺功能异常患病率高达8.5%,以亚临床甲状腺功能减退症最为多见,女性患病率高于男性。目的探讨和分析宁波市某石化企业员工代谢综合征的患病率及其分布特点。方法采用普查方法,调查了该企业10461名20-90岁男女员工的完整资料。代谢综合征诊断标准采用国际糖尿病联盟2005年关于代谢综合征的诊断标准(IDF共识标准)。结果①该企业员工中心性肥胖、血压升高或高血压、血糖升高或糖尿病、低高密度脂蛋白胆固醇(HDL-C)血症、高甘油三酯(TG)血症和代谢综合征的患病率分别为21.2%、43.5%、11.1%、12.1%、27.1%和10.2%。②按2000年全国人口构成标化,代谢综合征的标化患病率为5.8%,男性患病率与标化患病率分别为10.1%和5.9%,女性患病率与标化患病率分别为10.5%和5.7%。③上述代谢异常患病率随年龄增长而升高,其中40岁以上人群血糖升高或糖尿病、血压升高或高血压及代谢综合征的患病率为40岁以下人群的2-9倍。结论该石化企业员工具有较高的代谢综合征及其相关疾病的患病率。目的探讨甲状腺功能异常与代谢综合征及其各组分的关系。方法调查10461名年龄20-90岁的宁波市某石油化工企业员工人群,测定其体重指数、腰围、血压、空腹血糖和血脂谱。采用2005年国际糖尿病联盟(IDF)标准诊断代谢综合征。结果①该企业员工甲状腺功能异常和代谢综合征的患病率分别为4.6%和10.2%；②有近1／5员工存在腰围超标并含至少一项代谢异常；③TSH降低、正常和升高三组间代谢综合征的患病率未见有显著差异；④代谢综合征5项组分中,经logistic回归分析显示,低HDL-C与TSH减低有关(OR=2.808,95%CI：1.632-4.833),高TG与TSH升高有关(OR=1.483,95%CI：1.128-1.950)；⑤进一步分析TSH水平与血脂谱的关系,男性仅TC和HDL-C随TSH减低而降低；女性除Apo(A1)外,TC、LDL-C、TG、Apo(B)随TSH升高而逐渐升高,HDL-C在TSH异常组都呈显著降低。结论甲状腺功能异常与代谢综合征之间未见有明显相关性。甲状腺功能对于代谢综合征各组分的影响,主要表现为血脂谱改变,故对甲状腺功能异常者,有必要进行血脂检测。目的探讨甲状腺功能异常与高尿酸血症的关系。方法调查10461名20-90岁宁波市某石化企业员工人群,询问甲状腺疾病的手术、药物治疗史,检测血促甲状腺素(TSH)、游离甲状腺素(FT4)、游离三碘甲腺原氨酸(FT3)和血尿酸(SUA)。结果①该人群中高尿酸血症总患病率18.9%,男性23.6%,女性7.7%。②甲状腺疾病总体知晓率1.8%,男性0.8%,女性4.1%。③10272名否认甲状腺疾病史者中,甲状腺功能异常总患病率2.9%,男性患病率1.9%,其中TSH降低者0.3%,TSH升高者1.6%；女性患病率5.3%,其中TSH降低者0.8%,TSH升高者4.5%。④与TSH正常组相比,女性TSH升高组和降低组的血尿酸均显著升高(P<0.001)。⑤TSH升高是高尿酸血症的独立影响因素(OR值男性为1.93、女性为1.97,P<0.001)。结论高尿酸血症患病率与TSH升高独立相关,临床或亚临床甲状腺功能减退症可能是高尿酸血症的危险因素。目的探讨亚临床甲状腺功能减退症对血管内皮功能的影响。方法对70例30-55岁经健康体检无显著心血管疾病或甲状腺手术史者(其中35例甲状腺功能正常对照者,35例TSH 4.7-9.9mU／L的亚临床甲状腺功能减退症者),应用高分辨率超声显像法检测其肱动脉血管内皮依赖性舒张功能。结果两组的肱动脉内径基础值(分别为3.82±0.25mm和3.83±0.25mm)及含服硝酸甘油后肱动脉内径变化百分率(分别为17.8%±5.5%和17.3%±5.4%),均无显著性差异,亚临床甲状腺功能减退症组反应性充血后肱动脉内径变化的百分率(16.0%±4.5%)较正常对照组(16.4%±6.7%)也无显著降低(P>0.05)。结论轻中度亚临床甲状腺功能减退症患者不存在血管内皮功能障碍,TSH升高本身可能不是心血管病的直接危险因素。更多还原

【Abstract】 Objective To estimate the prevalence of thyroid dysfunction among the staff of a Petrochemical Corporation in Ningbo. Methods A population survey was conducted.10461 workers (including retired workers) were enrolled. Their medical history were investigated by questionairys,and blood samples were collected for thyroid function detection. Results In this petrochemical employees cohort, the prevalences of thyroid dysfunctions were 4.62%,2.70% and 9.11% in total population, male and female, repectively, while the standardized rates were 2.95%,2.06% and 5.31%, accordingly. The prevalence of diagnosed thyroid diseases was 1.81%,0.86% in male and 4.09% in female. Twenty-five percent of individuals with thyroid surgery or medications had abnormal thyroid function. The prevalence of unrecognized thyroid dysfunctions was 2.87%,1.88% in male and 5.29% in female. Subclinical hypothyroidism accounted for 81.7% of unrecognized thyroid dysfunctions.The prevalence of subclincical hypothyroidism was higher in aged people over 70 yrs than in other ages. Conclusions The prevalence of thyroid dysfunctions was over 4.5% in all workers of a Petrochemical Corporation in Ningbo. Subclinical hypothyroidism was the most popular form in all kinds of unrecognized thyroid functional disorders. The prevalence of subclinical hypothyroidism increased with age and was higher in female than in male.Objective To estimate the prevalence of thyroid dysfunctions among the retired staff of a Petrochemical Corporation in Ningbo. Methods A population survey was conducted.1759 retired workers over age 60 years were investigated to participate in a health survey with a questionnaire, and blood samples were collected for thyroid function detection. Results In this elderly cohort, the prevalence of diagnosed thyroid diseases was 3.9%,7.6% in female and 1.9% in male. The prevalence of unrecognized thyroid dysfunctions was 4.7%,6.9% in female and 3.5% in male. The prevalence of total thyroid dysfunctions was 8.5%,14.0% in female and 5.4% in male. Subclinical hypothyroidism accounted for 81.0% of unrecognized thyroid dysfunctions. The prevalence of thyroid dysfunction was higher in elderly people than in non-elderly persons.Conclusions The prevalence of thyroid dysfunctions was over 10% in the elderly retired workers of a Petrochemical Corporation in Ningbo. Subclinical hypothyroidism was the most popular form in all kinds of unrecognized thyroid functional disorders. The prevalence of subclinical hypothyroidism was higher in females than in males.Objective To explore the prevalence of metabolic syndrome in an occupational population.Methods The data of totally 10461 employees aged 20-90 collected from a Petrochemical Corporation in Ningbo were analyzed. The prevalence of metabolic syndrome was calculated using the criteria of IDF definition pulished in 2005. Results①The prevalence of central overweight, blood pressure over 130/85 mmHg or hypertension, impaired fasting glucose or diabetes mellitus, low HDL-C, high TG and metabolic syndrome were 21.2%、43.5%、11.1%、12.1%、27.1% and 10.2%.②The standardized prevalence of metabolic syndrome was 5.8%. The prevalence of metabolic syndrome was 10.1% in male and 10.5% in female, while the standardized rates were 5.9% and 5.7%, accordingly.③The prevalence of these diseases were increased with aging, and compared with the people yonger than 40 years old, the prevalence of hyperglucemia, hyertention and metabolic syndrome were 2-9 times higher in the people older than 40. Conclusion High prevalence of metabolic syndrome and its related diseases among the employees were observed in the Petrochemical Corporation in Ningbo. Objective To study the relationship between the prevalence of thyroid dysfunction and components of metabolic syndrome in Ningbo. Methods A total of 10461 workers aged 20 to 90 years of a Petrochemical Corporation in Ningbo were included. Body mass index (BMI), waist circumference, blood pressure, fasting plasma glucose and lipid profile concentrations were measured in all subjects. Metabolic syndrome was diagnosed according to the International Diabetes Federation (IDF) criteria. Results①The prevalences of metabolic syndrome and overall thyroid dysfunction were 10.2% and 4.6%, respectively.②About one fifth of petrochemical employees had abdominal obesity with at least one component of metabolic syndrome.③There was no significant difference in the prevalence of metabolic syndrome within lowered TSH, normal TSH and elevated TSH groups.④Logistic regression analyses revealed that low HDL-C was associated with lowered TSH (OR=2.808,95%CI:1.632-4.833), and high TG was associated with elevated TSH (OR=1.483,95%CI:1.128-1.950).⑤There were significant correlations between serum TSH levels and lipid parameters such as TC in males, TG and LDL-C in females, and HDL-C in both gender. Conclusion The prevalence of thyroid dysfunction was not associated with central obesity, hypertension and hyperglycemia. Lipid disorder was correlation with serum TSH levels.Objective To study the relationship between the prevalence of hyperuicemia and thyroid dysfunction. Methods 10461 active and retired workers aged 20 to 90 years of a Petrochemical Corporation in Ningbo were included. Serum thyroid-stimulatin hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3) and serum uric acid (SUA) were measured. Results①The prevalence of hyperuricemia was 18.9% in total workers,23.6% in males and 7.7% in females, respectively.②The prevalence of former diagnosed thyroid diseases was 1.8% in total,0.8% in males and 4.1% in females, respectively.③In 10272 individuals without a history of thyroid disease, the prevalence of thyroid dysfunction was 2.9% in total,1.9%in males and 5.3% in females, respectively. The percentage of subjects with a low TSH concentration was 0.3% in males and 0.8% in females; the percentage of subjects with an elevated TSH concentration was 1.6% in males and 4.5% in females.④Compared with normal TSH workers, the serum uric acid was significantly increased in subjects with either high TSH or low TSH (P<0.001) in females.⑤Logistic regression analysis revealed that low TSH was an independent factor associated with hyperuricemia (OR=1.93 for males and 1.97 for females, P all<0.001, respectively). Conclusion The prevalence of hyperuricemia was independently associated with increased TSH concentration. Overt or subclinical hypothyroidism may be risk factors for hyperuricemia.Objective To study the effect of mild subclinical hypothyroidism on the endothelium-dependent relaxing function in middle-aged persons. Methods Seventy participants in middle-aged persons without cardiovascular disease and thyroid surgry history were included in this study. Thirty-five of them with normal thyroid function and the others with little-mild subclinical hypothyroidism (TSH 4.7-9.9 mU/L). Endothelial-dependent relaxing function was measured with high-resolution B-mode ultrasound in all participants. Results Flow-mediated dilatation was not significantly impaired in the group of mild subclinical hypothyroidism compared with matched controls with normal thyoid function (16.0%±4.5% vs 16.4%±6.7%, P>0.05). There were no significant difference in baseline (3.82±0.25 mm vs 3.83±0.25 mm) and the nitroglycerin-induced dilatation (17.8%±5.5% vs 17.3%±5.4%) in two groups. Conclusion Endothelium-dependent relaxing function was not impaired in middle-aged patients with mild subclinical hypothyroidism, and mild increased TSH levels may not as a direct risk factor of cardiovascular disease.更多还原