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Article(id=1240375106912964705, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202308255, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1692028800000, receivedDateStr=2023-08-15, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773658070542, onlineDateStr=2026-03-16, pubDate=1711296000000, pubDateStr=2024-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773658070542, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773658070542, creator=13701087609, updateTime=1773658070542, updator=13701087609, issue=Issue{id=1240375105386238038, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773658070179, creator=13701087609, updateTime=1773658539618, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240377074414833974, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240377074414833975, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1017, endPage=1023, ext={EN=ArticleExt(id=1240375107160428648, articleId=1240375106912964705, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analyses of the incidence and influencing factors of thyroid diseases in perimenopausal women, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To assess the prevalence and identify risk factors of thyroid diseases among perimenopausal women, providing a theoretical basis for scientific prevention and control measures.

Methods

533 perimenopausal women in Shenzhen, aged 40-60, were statistically analyzed for demographics, living habits, residential pollution, and biochemical indicators, with multionmial logistic regression used to assess their links to thyroid disease occurrence.

Results

The prevalence of thyroid dysfunction in perimenopausal women was 37.0% (197/533). The prevalence of thyroid nodules was 49.7% (265/533) and 14.3% (76/533) in other thyroid ultrasound abnormalities types. The prevalence of thyroid ultrasound abnormalities accordingly tended to increase with age. Multionmial logistic regression analysis showed that systolic blood pressure (OR=1.066, 95% CI:1.024-1.110) and history of thyroid disease (OR=6.853, 95% CI:1.537-30.555) were the risk factors of thyroid dysfunction; 55-60 years old (OR=5.011, 95% CI:1.938-12.956), occupation of clerical staff (OR=3.332, 95% CI:1.196-9.282), diastolic blood pressure (OR=1.050, 95% CI:1.004-1.098), and history of thyroid disease (OR=6.704, 95% CI:1.820-24.698) were the risk factors of thyroid nodules; TGAb antibody positivity (OR=3.763, 95% CI: 1.177-12.031), occupation of technician (OR=4.196, 95% CI:1.259-13.983), systolic blood pressure (OR=1.036, 95% CI:1.005-1.068) and history of thyroid disease (OR=17.917, 95% CI:5.107-62.851) were the risk factors of thyroid dysfunction and ultrasound.

Conclusion

Thyroid dysfunction and nodule rates among perimenopausal women in Shenzhen (37.0% and 49.7%) exceed China's averages (19.9% and 23.7%). Heightened screening and early action for thyroid issues in this group are needed.

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目的

揭示围绝经期女性甲状腺疾病的患病情况及影响因素，为发现甲状腺疾病风险因素和防控措施提供理论依据。

方法

选取深圳市年龄在40~60岁的533名围绝经期女性为研究对象，对其人口学特征、生活习惯、居住地污染情况和临床生化指标进行统计分析，采用无序多分类logistic回归分析上述指标与甲状腺疾病发生的关联。

结果

围绝经期女性甲状腺功能异常的检出率为37.0 %（197/533），甲状腺结节的检出率为49.7 %（265/533），其他甲状腺超声异常的检出率为14.3 %（76/533）。甲状腺超声异常检出率随年龄增长而呈现上升趋势。无序多分类logistic回归分析结果显示，收缩压升高（OR=1.066，95% CI：1.024~1.110）和既往有甲状腺疾病史（OR=6.853，95% CI：1.537~30.555）是甲功异常的危险因素；年龄在55~60岁（OR=5.011，95% CI：1.938~12.956）、职业为文职人员（OR=3.332，95% CI：1.196~9.282）、舒张压升高（OR=1.050，95% CI：1.004~1.098）以及既往有甲状腺疾病史（OR=6.704，95% CI：1.820~24.698）是结节的危险因素；TGAb抗体阳性（OR=3.763，95% CI：1.177~12.031）、职业为技术人员（OR=4.196，95% CI：1.259~13.983）、收缩压升高（OR=1.036，95% CI：1.005~1.068）和既往有甲状腺疾病史（OR=17.917，95% CI：5.107~62.851）是甲状腺功能和超声均异常的危险因素。

结论

深圳地区围绝经期女性甲状腺功能异常和甲状腺结节的检出率分别为37.0%和49.7%，高于我国31省市女性甲功异常（患病率为19.9%）和甲状腺结节（患病率为23.7%）的平均水平，应加强对围绝经期女性甲状腺疾病的筛查并制定早期干预措施。

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张建清，E-mail：；
宋嘉宜，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=NTB6REuHatzjKtzHUYXyrQ==, magXml=orfLuUbAsSrebJYfSPB6iA==, pdfUrl=null, pdf=ex7PSEeK7oFb0f5y5POeJA==, pdfFileSize=740938, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=9Sk2p6dGABjUMx29wEvpvw==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=keK7RNTKebn/3sGhij+qyA==, mapNumber=null, authorCompany=null, fund=null, authors=

陆锦萍（2000—），女，硕士在读，研究方向：公共卫生

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陆锦萍（2000—），女，硕士在读，研究方向：公共卫生

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BMC Endocrine Disorders, 2022, 22(1): 2., articleTitle=Adjusted association between type 2 immunity and low risk thyroid nodules: a retrospective cohort study, refAbstract=null), Reference(id=1240746313751515596, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, doi=null, pmid=null, pmcid=null, year=2023, volume=34, issue=1, pageStart=70, pageEnd=73, url=null, language=null, rfNumber=[18], rfOrder=26, authorNames=何红春, journalName=公共卫生与预防医学, refType=null, unstructuredReference=何红春．成都地区450例健康体检居民碘营养及甲状腺结节检出情况及影响因素[J]．公共卫生与预防医学，2023，34（1）：70-73．, articleTitle=成都地区450例健康体检居民碘营养及甲状腺结节检出情况及影响因素, refAbstract=null), Reference(id=1240746313835401679, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, doi=null, pmid=null, pmcid=null, year=2023, volume=34, issue=1, pageStart=70, pageEnd=73, url=null, language=null, rfNumber=[18], rfOrder=27, authorNames=He HC, journalName=Journal of Public Health and Preventive Medicine, refType=null, unstructuredReference=He HC. Iodine nutrition status thyroid nodule detection and influencing factors in 450 health check-up residents in Chengdu[J]. Journal of Public Health and Preventive Medicine, 2023, 34(1): 70-73., articleTitle=Iodine nutrition status thyroid nodule detection and influencing factors in 450 health check-up residents in Chengdu, refAbstract=null), Reference(id=1240746313906704851, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, doi=null, pmid=null, pmcid=null, year=2020, volume=28, issue=9, pageStart=692, pageEnd=695, url=null, language=null, rfNumber=[19], rfOrder=28, authorNames=曹毅, 李斌, 陈柯余, journalName=中国慢性病预防与控制, refType=null, unstructuredReference=曹毅，李斌，陈柯余，等．女性甲状腺结节与生活及月经生殖因素的相关性分析[J]．中国慢性病预防与控制，2020，28（9）：692-695．, articleTitle=女性甲状腺结节与生活及月经生殖因素的相关性分析, refAbstract=null), Reference(id=1240746313978008023, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, doi=null, pmid=null, pmcid=null, year=2020, volume=28, issue=9, pageStart=692, pageEnd=695, url=null, language=null, rfNumber=[19], rfOrder=29, authorNames=Cao Y, Li B, Chen KY, journalName=Chinese Journal of Prevention and Control of Chronic Diseases, refType=null, unstructuredReference=Cao Y, Li B, Chen KY, et al. Analysis of the correlation between thyroid nodules andlife and menstrual reproductive factors in women[J]. Chinese Journal of Prevention and Control of Chronic Diseases, 2020, 28(9): 692-695., articleTitle=Analysis of the correlation between thyroid nodules andlife and menstrual reproductive factors in women, refAbstract=null)], funds=[Fund(id=1240746310811308356, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, awardId=22176132, language=CN, fundingSource=国家自然科学基金面上项目(22176132), fundOrder=null, country=null), Fund(id=1240746310891000137, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, awardId=JCYJ20210324135000001, language=CN, fundingSource=深圳市科创委面上项目(JCYJ20210324135000001), fundOrder=null, country=null), Fund(id=1240746311025217871, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, awardId=20221119115615564, language=CN, fundingSource=广东省医学科研基金(20221119115615564), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240746306252100600, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, xref=1., ext=[AuthorCompanyExt(id=1240746306273072123, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, companyId=1240746306252100600, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China), AuthorCompanyExt(id=1240746306302432252, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, companyId=1240746306252100600, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.中山大学公共卫生学院，广东 广州 510080)]), AuthorCompany(id=1240746306407288837, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, xref=2., ext=[AuthorCompanyExt(id=1240746306415677447, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, companyId=1240746306407288837, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.深圳市疾病预防控制中心持久性有机污染物研究室)])], figs=[ArticleFig(id=1240746309628514563, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, language=EN, label=Fig.1, caption=Forest plot of univariate analysis of influencing factors for thyroid diseases, figureFileSmall=02YTMAOSIqnyFP6eUzToUg==, figureFileBig=ONIgRMlw1O6eF4Fl+6uJug==, tableContent=null), ArticleFig(id=1240746309724983563, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, language=CN, label=图1, caption=甲状腺疾病影响因素单因素分析的森林图

注：1-A：围绝经期女性仅甲状腺功能异常的单因素logistic回归分析森林图；1-B：围绝经期女性仅甲状腺超声异常的单因素logistic回归分析森林图；1-C：围绝经期女性甲状腺功能和超声均异常的单因素logistic回归分析森林图。

, figureFileSmall=02YTMAOSIqnyFP6eUzToUg==, figureFileBig=ONIgRMlw1O6eF4Fl+6uJug==, tableContent=null), ArticleFig(id=1240746309825646865, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, language=EN, label=Table 1, caption=

Detection rates of thyroid dysfunction and ultrasound abnormalities among different age groups [n (%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
指标年龄（岁）趋势χ2P值
40~4445~4950~5455~60
甲状腺功能
正常117(63.6)86(67.7)64(60.4)69(59.5)0.040.849
异常67(36.4)41(32.3)42(39.6)47(40.5)
甲状腺超声
正常81(44.0)53(41.7)33(31.1)25(21.6)7.800.005
异常103(56.0)74(58.3)73(68.9)91(78.4)
), ArticleFig(id=1240746309930504472, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, language=CN, label=表1, caption=

不同年龄段甲状腺功能异常及超声异常的检出率[n（%）]

, figureFileSmall=null, figureFileBig=null, tableContent=
指标年龄（岁）趋势χ2P值
40~4445~4950~5455~60
甲状腺功能
正常117(63.6)86(67.7)64(60.4)69(59.5)0.040.849
异常67(36.4)41(32.3)42(39.6)47(40.5)
甲状腺超声
正常81(44.0)53(41.7)33(31.1)25(21.6)7.800.005
异常103(56.0)74(58.3)73(68.9)91(78.4)
), ArticleFig(id=1240746310039556381, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, language=EN, label=Table 2, caption=

Comparison of basic characteristics among perimenopausal women with different thyroid statuses [n (%)]

, figureFileSmall=null, figureFileBig=null, tableContent=
指标分组甲功＋超声均正常
(n =140)		仅甲功异常
(n =52)		仅有甲状腺结节
(n =147)		甲功＋超声均异常
(n =194)		合计
(n =533)		χ2P
年龄（岁）40~4462(44.3)19(36.5)39(26.5)64(33.0)184(34.5)26.500.002
45~4942(30.0)11(21.2)36(24.5)38(19.6)127(23.8)
50~5421(15.0)12(23.1)33(22.4)40(20.6)106(19.9)
55~6015(10.7)10(19.2)39(26.5)52(26.8)116(21.8)
BMI偏瘦5(3.6)1(2.0)4(2.8)6(3.1)16(3.1)16.440.058
正常101(73.2)32(64.0)97(67.4)105(55.0)335(64.1)
超重30(21.7)15(30.0)38(26.4)67(35.1)150(28.7)
肥胖2(1.4)2(4.0)5(3.5)13(6.8)22(4.2)
文化程度小学、初中及以下34(24.5)10(19.2)34(23.4)43(22.8)121(23.0)6.710.667
高中及中专36(25.9)9(17.3)28(19.3)35(18.5)108(20.6)
大专及本科62(44.6)28(53.8)77(53.1)102(54.0)269(51.2)
研究生及以上7(5.0)5(9.6)6(4.1)9(4.8)27(5.1)
职业文职人员32(22.9)14(27.5)43(29.5)45(23.6)134(25.4)26.880.030
技术人员13(9.3)10(19.6)20(13.7)43(22.5)86(16.3)
服务人员26(18.6)5(9.8)15(10.3)19(9.9)65(12.3)
家务31(22.1)6(11.8)24(16.4)27(14.1)88(16.7)
其他（农林牧渔水利业生产人员、军人或其他劳动者）19(13.6)8(15.7)16(11.0)34(17.8)77(14.6)
未就业或离退休人员19(13.6)8(15.7)28(19.2)23(12.0)78(14.8)
吸烟是1(0.7)2(3.8)1(0.7)5(2.6)9(1.7)4.010.261
否13(99.3)50(96.2)14(99.3)187(97.4)518(98.3)
饮酒是26(18.7)3(5.8)23(16.1)23(12.1)75(14.3)7.030.071
否113(81.3)49(94.2)120(83.9)167(87.9)449(85.7)
家里食盐加碘情况加碘103(75.2)42(80.8)97(67.8)125(66.5)367(70.6)18.030.026
不加碘18(13.1)7(13.5)37(25.9)47(25.0)109(21.0)
其他盐（如硒盐等）5(3.6)1(1.9)1(0.7)9(4.8)16(3.1)
加碘不加碘换着吃11(8.0)2(3.8)8(5.6)7(3.7)28(5.4)
既往是否有甲状腺疾病史是6(4.4)7(13.5)25(17.2)73(38.0)111(21.1)63.40<0.001
否131(95.6)45(86.5)120(82.8)119(62.0)415(78.9)
血缘亲属中是否有人曾被诊断为其他癌症是102(75.0)43(82.7)118(82.5)145(75.5)408(78.0)3.860.148
否34(25.0)9(17.3)25(17.5)47(24.5)115(22.0)
居住地附近是否有空气污染是31(22.3)12(23.1)23(16.0)26(13.5)92(17.5)5.670.122
否108(77.7)40(76.9)121(84.0)166(86.5)435(82.5)
), ArticleFig(id=1240746310165385509, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, language=CN, label=表2, caption=

不同甲状腺功能状态的围绝经期女性基本情况比较[n（%）]

, figureFileSmall=null, figureFileBig=null, tableContent=
指标分组甲功＋超声均正常
(n =140)		仅甲功异常
(n =52)		仅有甲状腺结节
(n =147)		甲功＋超声均异常
(n =194)		合计
(n =533)		χ2P
年龄（岁）40~4462(44.3)19(36.5)39(26.5)64(33.0)184(34.5)26.500.002
45~4942(30.0)11(21.2)36(24.5)38(19.6)127(23.8)
50~5421(15.0)12(23.1)33(22.4)40(20.6)106(19.9)
55~6015(10.7)10(19.2)39(26.5)52(26.8)116(21.8)
BMI偏瘦5(3.6)1(2.0)4(2.8)6(3.1)16(3.1)16.440.058
正常101(73.2)32(64.0)97(67.4)105(55.0)335(64.1)
超重30(21.7)15(30.0)38(26.4)67(35.1)150(28.7)
肥胖2(1.4)2(4.0)5(3.5)13(6.8)22(4.2)
文化程度小学、初中及以下34(24.5)10(19.2)34(23.4)43(22.8)121(23.0)6.710.667
高中及中专36(25.9)9(17.3)28(19.3)35(18.5)108(20.6)
大专及本科62(44.6)28(53.8)77(53.1)102(54.0)269(51.2)
研究生及以上7(5.0)5(9.6)6(4.1)9(4.8)27(5.1)
职业文职人员32(22.9)14(27.5)43(29.5)45(23.6)134(25.4)26.880.030
技术人员13(9.3)10(19.6)20(13.7)43(22.5)86(16.3)
服务人员26(18.6)5(9.8)15(10.3)19(9.9)65(12.3)
家务31(22.1)6(11.8)24(16.4)27(14.1)88(16.7)
其他（农林牧渔水利业生产人员、军人或其他劳动者）19(13.6)8(15.7)16(11.0)34(17.8)77(14.6)
未就业或离退休人员19(13.6)8(15.7)28(19.2)23(12.0)78(14.8)
吸烟是1(0.7)2(3.8)1(0.7)5(2.6)9(1.7)4.010.261
否13(99.3)50(96.2)14(99.3)187(97.4)518(98.3)
饮酒是26(18.7)3(5.8)23(16.1)23(12.1)75(14.3)7.030.071
否113(81.3)49(94.2)120(83.9)167(87.9)449(85.7)
家里食盐加碘情况加碘103(75.2)42(80.8)97(67.8)125(66.5)367(70.6)18.030.026
不加碘18(13.1)7(13.5)37(25.9)47(25.0)109(21.0)
其他盐（如硒盐等）5(3.6)1(1.9)1(0.7)9(4.8)16(3.1)
加碘不加碘换着吃11(8.0)2(3.8)8(5.6)7(3.7)28(5.4)
既往是否有甲状腺疾病史是6(4.4)7(13.5)25(17.2)73(38.0)111(21.1)63.40<0.001
否131(95.6)45(86.5)120(82.8)119(62.0)415(78.9)
血缘亲属中是否有人曾被诊断为其他癌症是102(75.0)43(82.7)118(82.5)145(75.5)408(78.0)3.860.148
否34(25.0)9(17.3)25(17.5)47(24.5)115(22.0)
居住地附近是否有空气污染是31(22.3)12(23.1)23(16.0)26(13.5)92(17.5)5.670.122
否108(77.7)40(76.9)121(84.0)166(86.5)435(82.5)
), ArticleFig(id=1240746310249271595, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, language=EN, label=Table 3, caption=

Comparison on blood pressure and clinical biochemical indices among perimenopausal women with different thyroid statuses[n(%) or ()]

, figureFileSmall=null, figureFileBig=null, tableContent=
指标甲功＋超声均正常
(n=140)		仅甲功异常
(n=52)		仅有甲状腺结节
(n=147)		甲功＋超声均异常
(n=194)		χ2 /H值P
TPOAb状况
阳性6(4.3)4(7.7)13(8.8)40(20.6)23.92<0.001
阴性132(95.7)48(92.3)134(91.2)154(79.4)20.65<0.001
TGAb状况
阳性8(5.7)1(1.9)18(12.2)36(18.6)23.92<0.001
阴性132(94.3)51(98.1)129(87.8)158(81.4)20.65<0.001
收缩压(mmHg)114.40±15.64121.69±16.72118.62±18.42121.35±16.7615.850.001
舒张压(mmHg)71.11±9.7872.29±10.1474.76±9.9074.01±11.149.420.024
HDL-C(mmol/L)1.45±0.411.46±0.391.41±0.441.50±0.415.670.129
LDL-C(mmol/L)3.14±0.823.16±0.823.22±0.753.16±0.791.500.682
TG(mmol/L)1.18±0.751.34±1.061.30±1.071.31±0.945.340.136
TC(mmol/L)4.99±1.005.03±0.925.09±0.925.13±0.913.140.370
FPG(mmol/L)4.95±0.814.97±0.745.15±1.454.99±0.8211.390.707
Cre(mmol/L)60.56±12.9960.10±10.5159.21±10.4960.76±11.571.950.583
SUA(mmol/L)283.66±70.40294.14±61.82278.87±62.98305.18±71.6516.600.001
), ArticleFig(id=1240746310375100721, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, language=CN, label=表3, caption=

不同甲状腺状态的围绝经期女性血压与临床生化指标比较[n(%)或() ]

, figureFileSmall=null, figureFileBig=null, tableContent=
指标甲功＋超声均正常
(n=140)		仅甲功异常
(n=52)		仅有甲状腺结节
(n=147)		甲功＋超声均异常
(n=194)		χ2 /H值P
TPOAb状况
阳性6(4.3)4(7.7)13(8.8)40(20.6)23.92<0.001
阴性132(95.7)48(92.3)134(91.2)154(79.4)20.65<0.001
TGAb状况
阳性8(5.7)1(1.9)18(12.2)36(18.6)23.92<0.001
阴性132(94.3)51(98.1)129(87.8)158(81.4)20.65<0.001
收缩压(mmHg)114.40±15.64121.69±16.72118.62±18.42121.35±16.7615.850.001
舒张压(mmHg)71.11±9.7872.29±10.1474.76±9.9074.01±11.149.420.024
HDL-C(mmol/L)1.45±0.411.46±0.391.41±0.441.50±0.415.670.129
LDL-C(mmol/L)3.14±0.823.16±0.823.22±0.753.16±0.791.500.682
TG(mmol/L)1.18±0.751.34±1.061.30±1.071.31±0.945.340.136
TC(mmol/L)4.99±1.005.03±0.925.09±0.925.13±0.913.140.370
FPG(mmol/L)4.95±0.814.97±0.745.15±1.454.99±0.8211.390.707
Cre(mmol/L)60.56±12.9960.10±10.5159.21±10.4960.76±11.571.950.583
SUA(mmol/L)283.66±70.40294.14±61.82278.87±62.98305.18±71.6516.600.001
), ArticleFig(id=1240746310471569715, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375106912964705, language=EN, label=Table 4, caption=

Multivariate logistic regression analysis of influencing factors for thyroid diseases among perimenopausal women

, figureFileSmall=null, figureFileBig=null, tableContent=
甲状腺疾病分类变量βSEWaldOR (95% CI)P值
仅甲状腺功能异常收缩压0.060.029.831.066(1.024~1.110)0.002
既往甲状腺疾病史1.930.766.376.853(1.537~30.555)0.012
仅甲状腺结节舒张压0.050.024.501.050(1.004~1.098)0.034
55~60岁1.610.4911.065.011(1.938~12.956)0.001
文职人员1.200.525.303.332(1.196~9.282)0.021
既往甲状腺疾病史1.900.678.186.704(1.820~24.698)0.004
甲功和超声均异常收缩压0.040.025.171.036(1.005~1.068)0.023
技术人员1.430.615.454.196(1.259~13.983)0.020
TGAb阳性1.330.594.993.763(1.177~12.031)0.025
既往甲状腺疾病史2.890.6420.3117.917(5.107~62.851)<0.001
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围绝经期女性甲状腺疾病影响因素的多因素logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
甲状腺疾病分类变量βSEWaldOR (95% CI)P值
仅甲状腺功能异常收缩压0.060.029.831.066(1.024~1.110)0.002
既往甲状腺疾病史1.930.766.376.853(1.537~30.555)0.012
仅甲状腺结节舒张压0.050.024.501.050(1.004~1.098)0.034
55~60岁1.610.4911.065.011(1.938~12.956)0.001
文职人员1.200.525.303.332(1.196~9.282)0.021
既往甲状腺疾病史1.900.678.186.704(1.820~24.698)0.004
甲功和超声均异常收缩压0.040.025.171.036(1.005~1.068)0.023
技术人员1.430.615.454.196(1.259~13.983)0.020
TGAb阳性1.330.594.993.763(1.177~12.031)0.025
既往甲状腺疾病史2.890.6420.3117.917(5.107~62.851)<0.001
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围绝经期女性甲状腺疾病患病情况调查及影响因素分析
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陆锦萍 1, 2 , 孔令权 2 , 林晓仕 2 , 卓兰 2 , 宋嘉宜 2 , 张建清 1, 2
现代预防医学 | 儿少卫生与妇幼保健 2024,51(6): 1017-1023
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现代预防医学 | 儿少卫生与妇幼保健 2024, 51(6): 1017-1023
围绝经期女性甲状腺疾病患病情况调查及影响因素分析
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陆锦萍1, 2, 孔令权2, 林晓仕2, 卓兰2, 宋嘉宜2 , 张建清1, 2
作者信息
  • 1.中山大学公共卫生学院，广东 广州 510080
  • 2.深圳市疾病预防控制中心持久性有机污染物研究室

    • 陆锦萍（2000—），女，硕士在读，研究方向：公共卫生

通讯作者:

张建清，E-mail：；
宋嘉宜，E-mail：
Analyses of the incidence and influencing factors of thyroid diseases in perimenopausal women
Jin-ping LU1, 2, Ling-quan KONG2, Xiao-shi LIN2, Lan ZHUO2, Jia-yi SONG2 , Jian-qing ZHANG1, 2
Affiliations
  • School of Public Health, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
出版时间: 2024-03-25 doi: 10.20043/j.cnki.MPM.202308255
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摘要
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目的

揭示围绝经期女性甲状腺疾病的患病情况及影响因素，为发现甲状腺疾病风险因素和防控措施提供理论依据。

方法

选取深圳市年龄在40~60岁的533名围绝经期女性为研究对象，对其人口学特征、生活习惯、居住地污染情况和临床生化指标进行统计分析，采用无序多分类logistic回归分析上述指标与甲状腺疾病发生的关联。

结果

围绝经期女性甲状腺功能异常的检出率为37.0 %（197/533），甲状腺结节的检出率为49.7 %（265/533），其他甲状腺超声异常的检出率为14.3 %（76/533）。甲状腺超声异常检出率随年龄增长而呈现上升趋势。无序多分类logistic回归分析结果显示，收缩压升高（OR=1.066，95% CI：1.024~1.110）和既往有甲状腺疾病史（OR=6.853，95% CI：1.537~30.555）是甲功异常的危险因素；年龄在55~60岁（OR=5.011，95% CI：1.938~12.956）、职业为文职人员（OR=3.332，95% CI：1.196~9.282）、舒张压升高（OR=1.050，95% CI：1.004~1.098）以及既往有甲状腺疾病史（OR=6.704，95% CI：1.820~24.698）是结节的危险因素；TGAb抗体阳性（OR=3.763，95% CI：1.177~12.031）、职业为技术人员（OR=4.196，95% CI：1.259~13.983）、收缩压升高（OR=1.036，95% CI：1.005~1.068）和既往有甲状腺疾病史（OR=17.917，95% CI：5.107~62.851）是甲状腺功能和超声均异常的危险因素。

结论

深圳地区围绝经期女性甲状腺功能异常和甲状腺结节的检出率分别为37.0%和49.7%，高于我国31省市女性甲功异常（患病率为19.9%）和甲状腺结节（患病率为23.7%）的平均水平，应加强对围绝经期女性甲状腺疾病的筛查并制定早期干预措施。

围绝经期  /  甲状腺功能  /  甲状腺结节  /  患病率  /  影响因素
Objective

To assess the prevalence and identify risk factors of thyroid diseases among perimenopausal women, providing a theoretical basis for scientific prevention and control measures.

Methods

533 perimenopausal women in Shenzhen, aged 40-60, were statistically analyzed for demographics, living habits, residential pollution, and biochemical indicators, with multionmial logistic regression used to assess their links to thyroid disease occurrence.

Results

The prevalence of thyroid dysfunction in perimenopausal women was 37.0% (197/533). The prevalence of thyroid nodules was 49.7% (265/533) and 14.3% (76/533) in other thyroid ultrasound abnormalities types. The prevalence of thyroid ultrasound abnormalities accordingly tended to increase with age. Multionmial logistic regression analysis showed that systolic blood pressure (OR=1.066, 95% CI:1.024-1.110) and history of thyroid disease (OR=6.853, 95% CI:1.537-30.555) were the risk factors of thyroid dysfunction; 55-60 years old (OR=5.011, 95% CI:1.938-12.956), occupation of clerical staff (OR=3.332, 95% CI:1.196-9.282), diastolic blood pressure (OR=1.050, 95% CI:1.004-1.098), and history of thyroid disease (OR=6.704, 95% CI:1.820-24.698) were the risk factors of thyroid nodules; TGAb antibody positivity (OR=3.763, 95% CI: 1.177-12.031), occupation of technician (OR=4.196, 95% CI:1.259-13.983), systolic blood pressure (OR=1.036, 95% CI:1.005-1.068) and history of thyroid disease (OR=17.917, 95% CI:5.107-62.851) were the risk factors of thyroid dysfunction and ultrasound.

Conclusion

Thyroid dysfunction and nodule rates among perimenopausal women in Shenzhen (37.0% and 49.7%) exceed China's averages (19.9% and 23.7%). Heightened screening and early action for thyroid issues in this group are needed.

Perimenopause period  /  Thyroid function  /  Thyroid nodules  /  Prevalence  /  Risk factors
陆锦萍, 孔令权, 林晓仕, 卓兰, 宋嘉宜, 张建清. 围绝经期女性甲状腺疾病患病情况调查及影响因素分析. 现代预防医学, 2024 , 51 (6) : 1017 -1023 . DOI: 10.20043/j.cnki.MPM.202308255
Jin-ping LU, Ling-quan KONG, Xiao-shi LIN, Lan ZHUO, Jia-yi SONG, Jian-qing ZHANG. Analyses of the incidence and influencing factors of thyroid diseases in perimenopausal women[J]. Modern Preventive Medicine, 2024 , 51 (6) : 1017 -1023 . DOI: 10.20043/j.cnki.MPM.202308255
正文
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1 前言
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近年来，甲状腺疾病的发病率逐年上升，已有研究表明沿海地区患病率高于内陆，女性患病率高于男性，且临床甲减、亚临床甲减以及甲状腺超声异常的患病率随年龄增长而增加[1-3]。已知甲状腺激素异常可能会增加心血管疾病、骨质疏松症和神经系统紊乱等其他不良健康结局的风险，并且与甲状腺结节的进展密切相关，特别是当促甲状腺激素（TSH）水平较高时，结节患者患恶性甲状腺肿瘤的风险也会增高[4]。围绝经期是女性由生育期向老年期过渡的特殊生理时期，体内激素失调和新陈代谢能力逐渐下降易引起多种疾病共同发生，甲功或超声异常也是围绝经期妇女的常见疾病[5]。然而，围绝经期女性在甲功异常或结节发病早期通常无显著症状，而后期出现的部分伴随症状则易被围绝经期综合征掩盖，往往只在完善相关检查、结节或肿块较大时才发现，从而导致医疗成本的升高，对于疾病早期发现和治疗带来了挑战。深圳作为一个经济发达、人口稠密的沿海城市，甲状腺疾病的发病率居高不下，围绝经期女性是临床或亚临床性疾病的高发人群，目前尚未有针对深圳地区围绝经期女性甲状腺疾病患病情况及影响因素的调查。
因此，本研究针对深圳市533名围绝经期女性的甲状腺疾病患病情况进行调查，为发现甲状腺疾病风险因素、高危人群筛查和早期科学防控提供参考，这对于降低甲状腺疾病的发病率，提升人群整体健康水平具有重要意义。
2 资料与方法
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2.1 研究对象
2017年9月至2018年12月期间在深圳市抽取4个行政区即宝安区、南山区、福田区和龙岗区，每个行政区随机抽取2个社区健康卫生服务中心即共8家社康。采用等容抽样方法，在每个社区抽取50户家庭，每户抽取1名18岁及以上的常住居民。此外，进一步纳入了2020年12月至2021年12月在罗湖区人民医院的体检人群。纳入标准：自愿签署知情同意书，调查前12个月内在深圳居住6个月以上且年龄在40~60岁的围绝经期女性。排除标准：怀孕或哺乳、患有严重心、肝、肾疾病者、长期服用影响新陈代谢药物、服用甲状腺激素、患有恶性肿瘤以及体检资料不完善者，最终纳入533名研究对象。本项目由深圳市疾病预防控制中心伦理委员会审批通过（深疾伦字〔2023〕第015A号）。
2.2 方法
（1）问卷调查：采用统一的调查问卷，由经过统一培训合格的调查员进行面对面调查。内容包括一般情况、食盐加碘情况、吸烟史、饮酒史、既往甲状腺疾病史和其他疾病史。其中，文职人员定义为在机关、党群、企业、事业单位或行政等部门的工作人员，技术人员定义为从事医疗、教师、法律、科技或科研等领域的工作人员。每周饮用含酒精的饮料1次以上并连续或累计6个月以上者定义为饮酒。每天吸一支以上并连续或累计6个月以上者定义为吸烟。居住地室外存在工业区或处于交通干线附近（1 km）等定义为居住地室外存在空气污染。（2）体格检查：由经过统一培训的调查人员对调查对象进行身高、体重和血压的测量，并计算身体质量指数（BMI），BMI=体重(kg) /身高(m)2。BMI分类标准：BMI<18.5 kg/m2为偏瘦，18.5~23.9 kg/m2为正常，24.0~27.9 kg/m2为超重，BMI≥28.0 kg/m2为肥胖[6]。（3）甲状腺超声检查：所有调查对象均由专业超声科医师进行甲状腺超声检查。（4）实验室检测：采集调查对象清晨空腹外周血5 ml采用Maglumi 2000全自动化学发光测定仪（深圳市新产业生物医学工程）进行甲功五项及两项抗体、血脂四项、血肌酐（Cre）、血尿酸（SUA）、空腹血糖（FPG）等血清学指标检测。
2.3 诊断标准
按《中国甲状腺疾病诊治指南》诊断甲状腺功能正常、亚临床甲亢、亚临床甲减、临床甲状腺功能亢进和临床甲状腺功能减退[7]。甲状腺结节：甲状腺超声提示存在囊性、单纯性或混合性甲状腺结节；其他甲状腺超声异常：经超声检查，弥漫性甲状腺肿、甲状腺腺瘤或腺体内部回声阳性；甲状腺超声正常：经甲状腺超声检查无结节及其他超声异常。
2.4 统计分析
应用SPSS 25.0进行统计分析。连续资料用均数±标准差（SD）表示，分类资料用频数和百分比表示。定量资料的组间比较采用Kruskal-Wallis检验；分类资料的组间比较采用卡方检验或Fisher检验。以甲状腺正常人群（作为参照）、仅甲功异常人群、仅结节人群以及甲功和超声均异常人群为因变量，采用无序多分类logistic回归分析围绝经期女性甲状腺疾病的影响因素。检验水准α=0.05。
3 结果
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3.1 围绝经期女性甲状腺疾病检出情况
533名围绝经期女性中，336例甲功正常（63.0%），197例甲功异常（37.0%）。罹患1种及1种以上甲状腺疾病393例，总患病率为73.7%。在197名甲功异常者中，除160例无法归类的甲状腺功能紊乱外，共有亚临床甲亢1例（2.7%）、临床甲亢4例（10.8%）、亚临床甲减32例（86.4%），检出率分别为0.2%、0.8%及6.0%。围绝经期女性甲功异常的检出率并未随年龄增长而呈现变化趋势（P>0.05）（表1）。
在533名围绝经期女性中，192例甲状腺超声正常者（36.0%），341例超声异常（64.0%）。在341名超声异常者中，结节为265例（77.7%），其他甲状腺超声异常76例（22.3%）。围绝经期女性的甲状腺超声异常的检出率随年龄增长而增加（趋势 χ2=7.80，P<0.01）。
3.2 不同甲状腺状态的围绝经期女性基本情况比较
533名围绝经期女性中，甲功及超声均正常者140例（26.3%）、仅甲功异常者52例（9.8%）、仅患有结节者147例（27.6%）、甲功及超声均异常者194例（36.4%）（表2）。不同甲状腺状态的围绝经期女性在年龄构成、职业分布、食盐加碘情况、既往甲状腺疾病史、甲状腺过氧化物酶抗体（TPOAb）阳性以及甲状腺球蛋白抗体（TGAb）阳性上差异有统计学意义（P<0.05），但各组之间的BMI、文化程度、吸烟史、饮酒史、癌症家族史及居住地附近是否有空气污染差异无统计学意义（P>0.05）。
3.3 不同甲状腺状态的围绝经期女性血压与临床生化指标比较
不同甲状腺状态的围绝经期女性在收缩压、舒张压、SUA水平上差异有统计学意义（P<0.05）（表3），但各组之间的Cre、FPG、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）的水平差异无统计学意义（P>0.05）。
3.4 深圳市围绝经期女性甲状腺疾病影响因素的单因素分析
单因素logistic回归分析结果显示，收缩压升高和既往有甲状腺疾病史是发生甲功异常的危险因素（图1-A）；舒张压升高、年龄在45~49岁、年龄在55~60岁以及既往有甲状腺疾病史是发生结节的危险因素，职业为服务人员以及家里食盐选择其他盐（如硒盐）者发生结节的风险降低（图1-B）；收缩压升高、舒张压升高、尿酸升高、TPOAb阳性、TGAb阳性、职业为技术人员、家里食盐选择其他盐（如硒盐）和既往有甲状腺疾病史者发生甲功和超声均异常的风险增高（图1-C）。
3.5 深圳市围绝经期女性甲状腺疾病影响因素的多因素分析
以上述单因素分析中有统计学意义的因素作为自变量纳入无序多分类logistic回归分析（表4）。结果显示，收缩压升高和既往有甲状腺疾病史的围绝经期女性发生甲功异常的风险增高；舒张压升高、年龄在55~60岁、职业为文职人员以及既往有甲状腺疾病史的围绝经期女性发生结节的风险增高；收缩压升高、职业为技术人员、TGAb阳性和既往有甲状腺疾病史的围绝经期女性发生甲状腺功能和超声均异常的风险增高。
4 讨论
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在本次调查的533名围绝经期女性中，甲功异常的检出率为37.0%，高于本市宝安区体检的育龄妇女（19.2%）；结节的检出率为49.7%，低于本市女性体检人群（53.2%）[8]。与Li等人在我国31省市进行的甲状腺疾病调查研究相比，本研究的患病率远高于其19.9%的女性甲功异常患病率和23.7%的女性甲状腺结节患病率[1]。而现有报道显示不同地区的患病率存在差异，碘营养状况的差异可能是原因之一。碘作为合成甲状腺激素的原料，摄入量与甲状腺疾病呈“U”型相关[9]。既往监测数据显示，虽然深圳属于沿海城市，但仍属于轻度碘缺乏地区，碘缺乏导致甲状腺疾病的风险仍不可忽视。
在单因素分析中发现围绝经期女性尿酸升高后发生甲功和超声均异常的风险随之增高。这与Wang的研究一致，可能与围绝经期性激素水平变化相关[10]。进一步采用多因素分析，结果显示舒张压升高是围绝经女性患甲状腺结节的危险因素，收缩压升高是患甲功、超声异常的危险因素，与已有研究一致[11-12]。血压对结节的影响可能与甲状腺激素水平有关，具体表现为血压升高会阻碍碘的吸收，导致血清TSH水平升高，从而刺激甲状腺滤泡上皮细胞过度增生，并分泌血管内皮因子进而诱发甲状腺结节[13]。
多项研究证实，女性比男性更容易患甲状腺疾病，Yin等人对体检人群的研究发现，女性甲状腺结节的患病率高于男性，且主要集中于40~59岁的围绝经期及绝经期[14]。本研究中，围绝经期女性甲功异常和结节的患病率较高，超声异常检出率随年龄增长呈上升趋势，且年龄在55~60岁患结节风险更高，原因可能与体内雌、孕激素水平随着年龄增长而变化有关。体外实验也表明，雌激素和孕酮可促进良性和恶性甲状腺细胞的增殖，同时随着年龄增长，自身免疫水平发生变化、性腺对促性腺激素的敏感性降低、甲状腺机能发生退行性变化，都有可能导致甲状腺激素水平发生变化[15-16]。此外，女性初潮年龄、生育史、生育年龄和绝经年龄等生殖因素可能也会影响围绝经期甲状腺疾病的发展。本研究发现TGAb阳性是甲功及超声均异常的危险因素，这与北京[17]和成都[18]对体检人群的研究结果一致，原因可能与甲状腺过氧化物酶的代谢通路受阻有关。本研究还发现，甲状腺疾病史是围绝经期女性甲功及超声异常的危险因素。有研究发现，可疑恶性结节组中既往有甲状腺疾病史的比例高于良性组，曾患过甲状腺疾病者，甲状腺激素调节可能存在障碍，或本身具有其他导致内分泌紊乱的易感因素，更容易导致甲状腺增生，发生甲状腺结节[19]。因此，对曾经罹患甲状腺疾病的围绝经期女性进行常规甲状腺检查，可能有助于减少疾病的发生。
本研究首次针对深圳地区围绝经期女性开展甲状腺疾病患病情况及可能影响因素调查，发现本地区围绝经期女性甲功异常和结节的检出率较高，且与血压升高、年龄增长、职业、既往甲状腺疾病史及TGAb阳性有关，建议将本地区围绝经期女性作为高危人群进行甲状腺疾病的重点监测，并进行生活行为方式等危险因素的干预，从而降低疾病的发病率、提升人群整体健康水平。
基金
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  • 国家自然科学基金面上项目(22176132)
  • 深圳市科创委面上项目(JCYJ20210324135000001)
  • 广东省医学科研基金(20221119115615564)
文献
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2024年第51卷第6期
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doi: 10.20043/j.cnki.MPM.202308255
  • 接收时间：2023-08-15
  • 首发时间：2026-03-16
  • 出版时间：2024-03-25
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  • 收稿日期：2023-08-15
基金
国家自然科学基金面上项目(22176132)
深圳市科创委面上项目(JCYJ20210324135000001)
广东省医学科研基金(20221119115615564)
作者信息
    1.中山大学公共卫生学院，广东 广州 510080
    2.深圳市疾病预防控制中心持久性有机污染物研究室

通讯作者:

张建清，E-mail：；
宋嘉宜，E-mail：
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https://castjournals.cast.org.cn/joweb/xdyfyx/CN/10.20043/j.cnki.MPM.202308255
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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