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目的 探讨老年患者低三碘甲腺原氨酸(T3)综合征和亚临床甲状腺功能减退(SCH)及血清同型半胱氨酸(Hcy)水平与代谢综合征(MS)的相关性.方法 回顾性分析2015年1月至2017年3月我院门诊和住院的60岁以上M S患者(M S组)83例及同期80例健康查体者(对照组)甲状腺功能、血脂、血糖、Hcy水平,低T3综合征组30例和SCH组41例.多因素Logistic回归分析甲状腺素水平、Hcy与MS组分的相关性.结果 MS患者低T3综合征和SCH的发病率分别为37.3％(31例)和49.4％(41例).低T3组、SCH组与对照组游离T3(FT3)、叶酸、Hcy、促甲状腺素(TSH)比较,差异有统计学意义(P<0.05).患者TSH>5.5 mU/L时,FT3降低(P<0.05),且TSH增高早于FT3降低;单因素相关分析,FT3与Hcy呈负相关(P<0.01);TSH与高密度脂蛋白胆固醇负相关(P<0.01);多因素线性回归分析,TSH与三酰甘油、Hcy相关(P<0.05).校正性别、体质指数因素后Logistic回归分析显示,FT3、Hcy、TSH与高血压相关(P<0.05);FT3降低(P<0.01)、Hcy升高(P<0.05)、TSH升高(P<0.05)是老年人发生MS的独立危险因素.结论 低T3综合征和SCH随增龄发病率增加;FT3、TSH、Hcy是老年人MS发生的独立危险因素.

Objective To explore the correlation of metabolic syndrome (MS ) with low triiodothyronine(T3)syndrome(LT3S ,or It is known as ESS :euthyroid sick syndrome) ,subclinical hypothyroidism (SCH )and a high serum total homocysteine (tHcy )level (hyperhomocysteinemia )in elderly patients. Methods We retrospectively analyzed thyroid function ,serum glucose ,lipids and homocysteine(Hcy)level in 83 MS patients(MS group) ,30 patients with low T3 syndrome(low T3 group) ,41 patients with SCH (SCH group)and 80 healthy individuals (control group)aged over 60 years from January 2015 to March 2017 in outpatient and inpatient departments of our hospital. The correlations of thyroid function and serum Hcy level with MS components were analyzed by multiple Logistic regression model. Results The incidence of low T3 syndrome and SCH in MS patients was 37.3％ (31/83)and 49.4％ (41/83) ,respectively.Low T3 group versus control group showed the lower levels in free triiodothyronine ,FT4 ,folic acid ,and Hcy ,with statistically significant differences (all P<0.05).SCH group versus control group showed a lower levels of FT 4 ,of Hcy and of folic acid ,but an increased TSH level ,with statistically significant differences (all P<0.05).Patients with TSH >5.5 mU/L had decreased FT3 which occurred later than the rise of TSH (P<0.05) .Univariate correlation analysis showed that FT3 was negatively correlated with Hcy (P< 0.01) ,and TSH was negatively correlated with high-density lipoprotein cholesterol(P<0.01).Multivariate linear regression analysis found linear correlations of TSH with triglyceride ,high-density lipoprotein cholesterol ,and Hcy(all P < 0.05).Logistic regression analysis showed that FT3 ,Hcy and TSH are highly associated with hypertension after adjustment for gender and body mass index (all P< 0.05).Decreased FT3(P<0.01) ,elevated Hcy(P<0.05) ,and increased TSH(P<0.05)were independent risk factors for MS in elderly patients. Conclusions The incidences of low T3 syndrome and SCH are increased with aging. FT3 ,TSH ,and Hcy are independent risk factors for MS in the elderly.