甲状腺功能正常的人群中受损的甲状腺激素 敏感性和高同型半胱氨酸血症的关系： 肌酐的中介作用
The Association between Impaired Sensitivity to Thyroid Hormones and Hyperhomocysteinemia in Euthyroid Individuals: Mediating Role of Creatinine
摘要: 目的：许多证据表明甲状腺激素对和心血管疾病显著相关的同型半胱氨酸(Hcy)产生影响，但只有少量关于甲状腺激素敏感性指数和Hcy关系的研究。因此本研究旨在探索中国甲状腺功能正常成年人中甲状腺激素敏感性指数和Hcy的关系，及以肌酐为代表的肾功能在此的相关统计学中介效应。方法：本研究纳入了9713名受试者，通过甲状腺激素计算甲状腺激素敏感性指数。运用线性回归和Logistc回归分析甲状腺激素敏感性指数和Hcy的关系。运用中介分析探索肌酐相关的统计学中介效应。结果：包括促甲状腺激素指数(TSHI)、促甲状腺激素抵抗指数(TT4R)、甲状腺反馈分位数指数(TFQI)、参数甲状腺反馈分位数指数(PTFQI)在内的甲状腺激素敏感性指数和Hcy呈正相关，肌酐在其中分别起到23.96%、24.88%、22.10%和22.87%的统计学中介效应。结论：甲状腺激素敏感性受损与Hcy升高相关，肌酐在其中具有统计学的中介效应。本研究为横断面研究无法探索因果关系，未来需要前瞻性的研究进一步验证因果关系。
Abstract: Objective: Considerable evidence showed that thyroid hormones have impact on homocysteine (Hcy) level which was strongly associated with cardiovascular disease. However, only a few research have shed light on the correlation between thyroid hormones sensitivity and Hcy. Consequently, our study aimed to explore how Hcy correlated with thyroid sensitivity-related parameters as well as the mediating role of creatinine (Cr) in euthyroid Chinese adults. Methods: This research included 9713 euthyroid participants in total. Thyroid hormones sensitivity indicators were derived from thyroid hormones. Linear regression models and logistic regression models were utilized to assess the correlation of thyroid hormones sensitivity with Hcy. Mediation analyses were performed to assess the statistical mediating role of creatinine. Results: As depicted in the outcomes of multiple linear regression and logistic regression analysis, indices of thyroid hormones sensitivity, including thyroid stimulating hormone index (TSHI), thyroid stimulating hormone resistance index (TT4RI), thyroid feedback quantile-based index (TFQI) and parametric thyroid feedback quantile-based index (PTFQI), were positively associated with Hcy level. Cr statistically significantly mediated 23.96%, 24.88%, 22.10% and 22.87% effect of TSHI, TT4QI, TFQI and PTFQI on Hcy. Conclusions: Reduced thyroid hormones sensitivity related to elevated Hcy level and Cr might statistically mediate this association. As this was a cross-sectional study, it could not establish causal relationships. Future prospective studies were needed to further validate causality.
文章引用：胡婧煜, 陈丽英. 甲状腺功能正常的人群中受损的甲状腺激素 敏感性和高同型半胱氨酸血症的关系： 肌酐的中介作用[J]. 临床医学进展, 2026, 16(3): 1680-1690. https://doi.org/10.12677/acm.2026.163953

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