甲状腺激素敏感性降低对老年骨质疏松女性高残余胆固醇的影响

doi:10.3969/j.issn.1006-5725.2026.07.020

摘要/Abstract

摘要：

目的探讨甲状腺功能正常的老年骨质疏松（OP）女性高残余胆固醇（RC）风险与甲状腺激素的敏感性之间的相关性。方法回顾性研究了2021年1月至2023年12月60岁以上甲状腺功能正常的老年OP女性住院患者共937例。正常RC水平组703例，为RC水平下3个四分位数，高RC水平组234例，为RC水平上四分位数。检测肝功能、肾功能、电解质、血脂及甲状腺功能指标。计算FT3/FT4比值、甲状腺反馈分位数指数（TFQI）、促甲状腺激素-甲状腺素抵抗指数（TT4RI）、促甲状腺激素指数（TSHI）及RC。采用二元logistic回归分析和限制性立方样条（restricted cubic spline，RCS）探讨老年OP女性高RC的危险因素及其与甲状腺激素敏感性的关系。结果（1）与正常RC水平组相比，高RC水平组TG、TC、LDL-C、FT4、TFQI、TSHI增加，HDL-C、FT3/FT4减少，差异有统计学意义（P < 0.05）。（2）TFQI、FT3/FT4比值为老年OP女性高RC的风险因素［OR分别为1.50（95%CI：1.04 ~ 216）、0.02（95%CI：0.00 ~ 0.76），P < 0.05］。（3）TFQI分层显示，其水平升高时，高RC风险也增加，而第3层中TFQI每升高1个单位，高RC风险增幅最大，达2.28倍，OR为2.28（95%CI：1.47 ~ 3.5），P < 0.05。（4）RCS分析发现TFQI与RC含量间呈倒U型相关，截点为0.304，与高RC风险也呈倒U型关系，当TFQI ≥ -0.021且≤ 0.772时，高RC风险增加。结论甲状腺激素敏感性受损是老年OP女性高RC的危险因素，TFQI与RC含量及高RC风险呈倒U型相关。

关键词: 甲状腺激素, 敏感性, 老年, 女性, 骨质疏松, 残余胆固醇

Abstract:

Objective To explore the association between the risk of high residual cholesterol （RC） and thyroid hormone sensitivity among elderly osteoporosis （OP） women with normal thyroid function. Methods This retrospective study recruited 937 hospitalized female OP patients aged 60 years or older with normal thyroid function from January 2021 to December 2023. Among them， 703 cases were assigned to the normal RC level group （Group A）， whose RC levels were in the lower three quartiles， and 234 cases were assigned to the high RC level group （Group B）， whose RC levels were in the upper quartile. Liver function， kidney function， electrolyte levels， blood lipid profiles， and thyroid function indicators were measured. The FT3/FT4 ratio， thyroid feedback quantile index （TFQI）， thyroid-stimulating hormone thyroid resistance index （TT4RI）， thyroid-stimulating hormone index （TSHI）， and RC were calculated. Binary logistic regression analysis and restricted cubic spline （RCS） were employed to explore the risk factors of high RC in elderly women with osteoporosis and its relationship with thyroid hormone sensitivity. Results （1） When compared with the normal RC level group， the levels of TG， TC， LDL-C， FT4， TFQI， and TSHI in the high RC level group were elevated， whereas the levels of HDL-C and the FT3/FT4 ratio were reduced in the high RC level group compared with group A （P < 0.05）. （2） TFQI and the FT3/FT4 ratio were identified as risk factors for high RC in elderly women with OP， and the odds ratios （ORs） were 1.50 （95%CI： 1.04-2.16） and 0.02 （95%CI： 0.00-0.76）， respectively， with P < 0.05. （3） TFQI stratification analysis indicated that as its level rose， the risk of high RC also increased. In the third stratum， for each unit increase in TFQI， the risk of high RC increased the most， reaching 2.28-fold， with an OR of 2.28 （95%CI： 1.47-3.54）， P < 0.05. （4） Restricted cubic spline analysis revealed an inverted U-shaped correlation between TFQI and RC content， with a cut-off point of 0.304， and an inverted U-shaped relationship with the risk of high RC. When TFQI was between -0.021 and 0.772 （inclusive）， the risk of high RC increased. Conclusion Impaired thyroid hormone sensitivity serves as a risk factor for high RC in elderly women with osteoporosis. The TFQI exhibits an inverse U-shaped correlation with RC content and the risk of high RC.

Key words: thyroid hormone, sensitivity, elderly, women, osteoporosis, residual cholesterol

中图分类号:

R683.2

徐艺筝,邹明,王秦. 甲状腺激素敏感性降低对老年骨质疏松女性高残余胆固醇的影响[J]. 实用医学杂志, 2026, 42(7): 1265-1271.

Yizheng XU,Ming ZOU,Qin WANG. Impact of reduced thyroid hormone sensitivity on high residual cholesterol in elderly women with osteoporosis[J]. The Journal of Practical Medicine, 2026, 42(7): 1265-1271.

参考文献 18

[1]	WANG J， SHU B， TANG D Z， et al. The prevalence of osteoporosis in China， a community based cohort study of osteoporosis［J］. Front Public Health， 2023， 11： 1084005. doi： 10.3389/fpubh.2023.1084005. eCollection 2023 . doi: 10.3389/fpubh.2023.1084005. eCollection 2023
[2]	LORENTZON M， JOHANSSON H， HARVEY N C， et al. Osteoporosis and fractures in women： The burden of disease［J］. Climacteric， 2022， 25（1）： 4-10. doi： 10.1080/13697137.2021.1951206 . doi: 10.1080/13697137.2021.1951206
[3]	中华医学会骨质疏松和骨矿盐疾病分会. 原发性骨质疏松症诊疗指南（2022）［J］. 中华内分泌代谢杂志， 2023， 39 （5）： 377-406. doi： 10.3760/cma.j.cn311282-20230321-00122 . doi: 10.3760/cma.j.cn311282-20230321-00122
[4]	ZHANG J， HU W， ZOU Z， et al. The role of lipid metabolism in osteoporosis： Clinical implication and cellular mechanism［J］. Genes Dis， 2023， 11（4）： 101122.doi： 10.1016/j.gendis.2023.101122 . doi: 10.1016/j.gendis.2023.101122
[5]	GANDA O P.Triglyceride-rich lipoproteins， remnant-cholesterol， and atherosclerotic cardiovascular disease［J］. Curr Opin Lipidol， 2023， 34（3）： 105-113. doi： 10.1097/MOL.0000000000000875 . doi: 10.1097/MOL.0000000000000875
[6]	HUANG H， XIE J， ZENG Y， et al. Remnant Cholesterol Independently Predicts the Development of Nonalcoholic Fatty Liver Disease［J］. J Clin Endocrinol Metab， 2023， 108（11）： 2907-2915.doi：10.1210/clinem/dgad272 . doi: 10.1210/clinem/dgad272
[7]	ZHANG Q， HUANG S， CAO Y， et al. Remnant cholesterol and mild cognitive impairment： A cross-sectional study［J］. Front Aging Neurosci， 2023， 15： 1069076. doi： 10.3389/fnagi.2023.1069076 . doi: 10.3389/fnagi.2023.1069076
[8]	HOU X， ZHANG N， GUO L， et al. Cumulative exposure to remnant cholesterol and the risk of fragility fractures： A longitudinal cohort study［J］. Front Endocrinol （Lausanne）， 2023， 14： 1251344. doi： 10.3389/fendo.2023.1251344 . doi: 10.3389/fendo.2023.1251344
[9]	SUN H， ZHU W， LIU J， et al. Reduced Sensitivity to Thyroid Hormones Is Associated With High Remnant Cholesterol Levels in Chinese Euthyroid Adults［J］. J Clin Endocrinol Metab， 2022， 108（1）： 166-174. doi： 10.1210/clinem/dgac523 . doi: 10.1210/clinem/dgac523
[10]	LACLAUSTRA M， MORENO-FRANCO B， LOU-BONAFONTE J M， et al. Impaired Sensitivity to Thyroid Hormones Is Associated With Diabetes and Metabolic Syndrome［J］. Diabetes Care， 2019， 42（2）： 303-310. doi： 10.2337/dc18-1410 . doi: 10.2337/dc18-1410
[11]	BRETA G， BERG G， MIKSZTOWICZ V， et al. Atherogenic Lipoproteins in Subclinical Hypothyroidism and Their Relationship with Hepatic Lipase Activity： Response to Replacement Treatment with Levothyroxine［J］. Thyroid， 2016， 26（3）： 365-372. doi： 10.1089/thy.2015.0140 . doi: 10.1089/thy.2015.0140
[12]	徐文，邹明，池继敏. 残余胆固醇与老年女性骨质疏松骨折及骨代谢相关性研究［J］. 中国骨质疏松杂志， 2024， 30 （11）： 1574-1580. doi： 10.3969/j.issn.1006-7108.2024.11.003 . doi: 10.3969/j.issn.1006-7108.2024.11.003
[13]	CHEN S， HUANG W， ZHOU G， et al. Association between Sensitivity to Thyroid Hormone Indices and Bone Mineral Density in US Males［J］. Int J Endocrinol， 2022， 2022： 2205616. doi： 10.1155/2022/2205616 . doi: 10.1155/2022/2205616
[14]	LIU C， HUA L， LIU K， et al. Impaired sensitivity to thyroid hormone correlates to osteoporosis and fractures in euthyroid individuals［J］. J Endocrinol Invest， 2023， 46（10）： 2017-2029. doi： 10.1007/s40618-023-02035-1 . doi: 10.1007/s40618-023-02035-1
[15]	KANG J， ZHAO S， WU X， et al. The association of lipid metabolism with bone metabolism and the role of human traits： A Mendelian randomization study［J］. Front Endocrinol （Lausanne）， 2023， 14： 1271942. doi： 10.3389/fendo.2023.1271942 . doi: 10.3389/fendo.2023.1271942
[16]	KAN B， ZHAO Q， WANG L， et al. Association between lipid biomarkers and osteoporosis： A cross-sectional study［J］. BMC Musculoskelet Disord， 2021， 22（1）： 759. doi： 10.1186/s12891-021-04643-5 . doi: 10.1186/s12891-021-04643-5
[17]	CUI G， XU N， ZHAO S， et al. TC and LDL-C are negatively correlated with bone mineral density in patients with osteoporosis［J］. Am J Transl Res， 2024， 16（1）： 163-178. doi： 10.62347/DTXZ3175 . doi: 10.62347/DTXZ3175
[18]	ZHAO X， SUN J， XIN S， et al. Correlation between Blood Lipid Level and Osteoporosis in Older Adults with Type 2 Diabetes Mellitus-A Retrospective Study Based on Inpatients in Beijing， China［J］. Biomolecules， 2023， 13（4）： 616. doi： 10.3390/biom13040616 . doi: 10.3390/biom13040616