Abstract:

Objective　To explore the correlation of visceral fat area (VFA) and serum homocysteine (Hcy) with subclinical hypothyroidism (SCH) in patients with Hashimoto's thyroiditis (HT). Methods　A total of 194 patients with HT admitted to Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine from March 2023 to November 2024 were selected for the case control study. According to whether the patients were complicated with SCH, they were divided into a combined group (38 cases) and a non-combined group (156 cases). The VFA and serum Hcy level were measured in all the patients, and the clinical related data were collected. χ² test and t test were used to compare the clinical data. The logistic regression analysis was used to analyze the independent influencing factors. The receiver operating characteristic curve (ROC) was used to analyze the diagnostic value. The Pearson method was used to analyze the correlation. Results　The age [(61.31±4.72) years vs. (57.36±4.78) years], proportion of females [92.11% (35/38) vs. 72.44% (113/156)], levels of thyroid peroxidase antibody (TPOAb) [(55.48±6.16) IU/ml vs. (52.43±5.83) IU/ml] and thyroid stimulating hormone (TSH) [(5.81±1.20) uIU/ml vs. (3.24±1.05) uIU/ml], VFA [(87.36±24.96) cm² vs. (60.44±17.28) cm²], and levels of Hcy [(17.21±4.30) mmol/L vs. (11.54±2.87) mmol/L] and thyroglobulin antibody (TgAb) [(46.32±5.15) IU/ml vs. (43.87±4.87) IU/ml] in the combined group were higher than those in the non-combined group (t=4.579, P<0.001; χ²=6.535, P=0.011; t=2.860, P=0.005; t=13.148, P<0.001; t=7.831, P<0.001; t=9.808, P<0.001; t=2.750, P=0.007). The logistic regression analysis showed that age (OR=2.031, 95%CI 1.178-3.502), gender (OR=3.218, 95%CI 1.229-8.424), TSH level (OR=2.375, 95%CI 1.555-3.626), VFA (OR=6.089, 95%CI 2.197-16.872), and Hcy level (OR=4.642, 95%CI 2.296-9.381) were independent influencing factors for SCH in the patients (all P<0.04). The ROC showed that the sensitivities of VFA, Hcy, and their combination in the diagnosis of SCH in the patients were 71.10%, 73.70%, and 86.80%, respectively; the specificities were73.10%, 75.00%, and 91.70%, respectively;the areas under the curves were 0.781, 0.807, and 0.918, respectively (all P<0.001). VFA and Hcy level were positively correlated with TSH levels in the HT patients with SCH (r=0.632 and 0.577; P=0.001 and 0.003). Conclusions　VFA and Hcy are independent risk factors for SCH in patients with HT; their levels are positively correlated with the serum TSH level in patients with HT combined with SCH, and have certain diagnostic value for the occurrence of SCH in patients with HT.

Key words: Hashimoto's thyroiditis,  , Visceral fat area,  , Homocysteine,  , Subclinical hypothyroidism,  , Influencing factors

摘要：

目的　探究内脏脂肪面积（visceral fat area，VFA）和血清同型半胱氨酸（homocysteine，Hcy）水平与桥本甲状腺炎（Hashimoto’s thyroiditis，HT）患者合并亚临床甲状腺功能减退症（subclinical hypothyroidism，SCH）的相关性。方法　选取陕西中医药大学第二附属医院2023年3月至2024年11月收治的194例HT患者进行病例对照研究。根据患者是否合并SCH将其分为合并组（38例）和未合并组（156例）。检测患者VFA与血清Hcy水平，收集临床相关资料。临床资料比较采用χ2检验和t检验。logistic回归分析独立影响因素，受试者操作特征曲线（receiver operating characteristic，ROC）分析诊断价值，Pearson法分析相关性。结果　合并组年龄［（61.31±4.72）岁比（57.36±4.78）岁］、女性占比［92.11%（35/38）比72.44%（113/156）］、甲状腺过氧化物酶抗体（anti-thyroid peroxidase antibody，TPOAb）水平［（55.48±6.16）IU/ml比（52.43±5.83）IU/ml］、促甲状腺激素（thyroid stimulating hormone，TSH）水平［（5.81±1.20）uIU/ml比（3.24±1.05）uIU/ml］、VFA［（87.36±24.96）cm2比（60.44±17.28）cm2］、Hcy水平［（17.21±4.30）mmol/L比（11.54±2.87）mmol/L］、甲状腺球蛋白抗体（thyroglobulin antibodies，TgAb）水平［（46.32±5.15）IU/ml比（43.87±4.87）IU/ml］均高于未合并组（t=4.579，P<0.001；χ2=6.535，P=0.011；t=2.860，P=0.005；t=13.148，P<0.001；t=7.831，P<0.001；t=9.808，P<0.001；t=2.750，P=0.007）。logistic回归分析结果显示，年龄（OR=2.031，95%CI 1.178～3.502）、性别（OR=3.218，95%CI 1.229～8.424）、TSH水平（OR=2.375，95%CI 1.555～3.626）、VFA（OR=6.089，95%CI 2.197～16.872）、Hcy水平（OR=4.642，95%CI 2.296～9.381）是HT患者合并SCH的独立影响因素（均P<0.05）。ROC显示，VFA、Hcy及二者联合诊断HT患者合并SCH的灵敏度分别为71.10%、73.70%、86.80%、，特异度分别为73.10%、75.00%、91.70%，曲线下面积分别为0.781、0.807、0.918（均P<0.001）。HT合并SCH患者VFA、Hcy水平与TSH水平呈正相关（r=0.632、0.577，P=0.001、0.003）。结论　VFA、Hcy是HT患者合并SCH的独立危险因素，且其水平与HT合并SCH患者血清TSH水平呈正相关，对HT患者发生SCH有一定的诊断价值。

关键词: 桥本甲状腺炎, 内脏脂肪面积, 同型半胱氨酸, 亚临床甲状腺功能减退症, 影响因素