亚临床甲减课件幻灯

The colorado thyroid disease prevalence study
筛查1995年25862名COLORADO地区的常住人口显示
高TSH 的患病率与年龄和性别相关
25
Male Female
20
高TSH 的患病率 %
15
10
5
.
0 18-24
25-34 35-44 45-54 55-64
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
N=912
随访20年
追踪20年发展为临床甲减： 单纯TSH增高者33% 单纯抗体阳性者27% 二者均高55%
Whickham 甲减发生与基线TSH有关
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
亚临床甲状腺功能减退症患病率
• 碘充足地区多因自身免疫性疾病引起 老年女性常见，女：男为10：1
• 碘缺乏区发病率与高碘区相比为1：10
• 中国医大：三个不同尿碘区（103ug/L,315ug/L,615ug/L）
亚临床甲减和临床甲减患病率均随尿碘增加而增加 亚临床甲减患病率高于临床甲减
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
38倍于TSH及抗体阴性的妇女。
(抗甲状腺过氧化物酶抗体或抗甲状腺球蛋白抗体）
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
• 老年患病率为7~26% • 最近一项调查，大于74岁男性（16%）几乎与
同龄女性（21%）的患病率一样高。
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
Colorado Thyroid Disease Prevalence Study
• ＞25000常住人口—22842甲功正常 2336（9.5%）亚临床甲减
• 75%的TSH 在5-10mIU/L的范围内. • 2336名轻度甲状腺衰竭者临床表现：
皮肤干燥(28% p<0.001) 记忆力差(24% p<0.001) 思维迟钝(22% p<0.001) 肌无力(22% p<0.001) 疲劳(18% p<0.01) 肌肉痉挛(17 p<0.001) 怕冷(15% p<0.001) 眼浮肿(12% p<0.05) 便秘(8% p<0.05 ) 声音嘶哑(7% p=0.05).
亚临床甲减转归
1972-1974年期间，在英国一城市 随机抽选成年人2800名，随访20年
• Whickham 研究, 一个英国的城市的 35岁以上女性 8%有亚临床甲减. 20年后40%的亚临床甲减发展为临 床甲减。老年,女性, 和抗甲状腺抗体阳性是发展为临 床甲减的高危因素
• 女性抗体阴性﹢轻度TSH上升每年2.6%转为临床甲减 • 女性抗体阳性﹢ TSH正常， 每年2.1%转为临床甲减 • 女性抗体阳性﹢ TSH升高 每年5% 转为临床甲减
亚临床甲减--又称轻度甲状腺衰竭
Subclinical hypothyroidism---- mild thyroid failure
• 定义: 系指血清TSH升高，甲状腺激素FT3、 FT4水平正常
• 人群筛查的整体患病率为4~10%(6 %), 与年 龄性别相关,老年、女性多见,女:男约2-3:1 世界范围内报告患病率从 1%到10%不等
TSH水平升高就意谓甲状腺激素是缺少的
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
亚临床甲减的病因
• 甲状腺自身免疫性疾病为主---抗甲状腺抗体常阳性， 甲状腺淋巴细胞浸润占20-30%
• 其他病因包括： 甲亢的治疗过度，
颈部放射治疗史、 产后甲状腺炎、 特定的自身免疫疾患，尤其是1型糖尿病。
含碘抗心律失常药物如胺碘酮、锂或碘, 产后甲状腺， 细胞因子如干扰素
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
只要血清 TSH 水平增高, 甲状腺激素 水平不会真正正常
• T4 的半衰期为 7 天， T3 为 1 天, 而血清TSH 半衰期 不到1小时，如果甲状腺激素确实是正常，TSH肯定应 恢复正常.
• TSH 水平在正常参考值的上限 (3~5mIU/L)时，一半 患者对TRH反应超常，说明可能已有亚临床甲减
Colorado 研究
18
症 16 状 发 14 生 率 12
10
N=22842 12.1%
N=2336
13.7%
与正常比 p<0.05
N=114 16.6%
%
8 6ห้องสมุดไป่ตู้
4 Euthyroid
亚甲减
Hypothyroid
参加者接受甲状腺激素缺乏相关症状的问卷调查., 亚临床甲减症状发生率为13.7%, 临床甲减为16.6% ---均较高于甲功正常者(P<0.05)
自然史
• 亚临床甲减是甲减的早期阶段，每年约有 3~18% 发展 为临床甲减。
• 一项评价亚临床甲减自然病史的研究： 154名女性，随访10年后显示： 57%的患者仍持续是亚临床甲减 34%患者发展为临床甲减 9%的患者TSH转为正常，这9%的患者中有多 少曾是一过性甲状腺炎如静息性，亚急性或 产 后甲状腺炎不得而知。
65-74
>74
Age
With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society
Colorado 研究
详细的询问可以发现很多（30%）患者都有轻微、
非特异的症状
血清TSH在5-10mIU/L之间，随TSH升高胆固醇 水平逐渐升高
这种非常常见的综合征称轻度甲减可能更合适
Arch Intern Med 160:526-534 1997 J Clin Endocrinol Metab 82:771-776