Objective: Using clinical "big data" , to investigate the factors that affect the levels of thyroid hormones, and to explore the partitioning criteria for reference intervals (RI) of these hormones. Methods: An observation study was conducted. Information of 107 107 individuals undergoing routine physical examination in Peking Union Medical College Hospital from September 1(st,) 2013 to August 31(st,) 2016 was collected, thyroid hormone of these subjects were detected. To explore the test results distribution and differences of TSH, FT4 and FT3 by gender and age; according to the seasonal division standard of China Meteorological Administration, the study period was divided into four seasons, and the seasonal fluctuation on TSH was analyzed.To define the appropriate partition by gender, age and season according to significant difference analysis. Results: In male and female, the distributions of TSH were 1.779(0.578-4.758), 2.023(0.420-5.343)mU/L, respectively, and the level of TSH in female was higher than in male (Z=-37.600, P<0.001). The distributions of FT4 were 0.127(0.098-0.162), 0.117(0.091-0.151) μg/L, the distributions of FT3 were 3.33(2.47-3.74), 3.01(2.35-3.57)ng/L. And the level of FT4, FT3 in female were significantly lower than in male (Z=-94.000, -154.600, all P<0.001). Furthermore, males were divided into two groups by 65 years old and female were divided by 50 years old, respectively, and the distributions of TSH in male and female of older group were 1.818(0.528-5.240), 2.111(0.348-5.735)mU/L, in younger group were 1.778(0.582-4.696), 1.991(0.427-5.316)mU/L. The level of TSH in older group was significantly higher than in younger group (Z=-2.269, -10.400, all P<0.05), and the distribution of TSH in older group was much wider than in younger. The distribution of whole in spring, summer and autumn was 1.869( 0.510-5.042)mU/L, in winter was 1.978(0.527-5.250) mU/L, and the difference between them had statistical significance (Z=-15.000, P<0.001). Conclusions: Gender and age significantly affect the serum levels of TSH, FT4, and FT3, the distribution of TSH in female and elder group are wider than in male, and that of FT4, FT3 are lower.Seasons significantly affect the serum TSH level, the peak value is observed in winter. There are obviously differences between "rough" RIs and manufacture recommended RIs. Each laboratory should establish reference intervals for thyroid hormones on the premise of appropriate grouping.
目的： 利用临床"大数据"，探讨甲状腺激素水平的影响因素，并探讨适合的参考区间数据分组方案。分析不同分组下激素水平的人群分布特征。 方法： 回顾性研究。调取2013年9月1日至2016年8月31日北京协和医院共107 107例含甲状腺功能检测数据的健康体检者信息。探讨不同性别、年龄组促甲状腺素(TSH)、游离甲状腺素(FT4)、游离三碘甲状腺原氨酸(FT3)的数据分布及差异的显著性；按照国家气象局季节划分标准，将研究期划分为四季，分析TSH随季节变化的趋势。根据差异显著性进行性别、年龄及季节分组，研究数据分布与制造商推荐参考区间的关系。 结果： 男性、女性TSH水平分别为1.779(0.578～4.758)、2.023(0.420～5.343)mU/L，女性TSH水平高于男性(Z＝－37.600，P<0.001)。男性、女性FT4水平分别为0.127(0.098～0.162)、0.117(0.091～0.151)μg/L，FT3水平分别为3.33(2.47～3.74)、3.01(2.35～3.57)ng/L，女性FT4、FT3水平低于男性(Z＝－94.000、－154.600，均P<0.001)。进一步按照年龄分组，男性以≥65岁为高龄组，女性以≥50岁为高龄组，男性、女性高龄组TSH分别为1.818(0.528～5.240)、2.111(0.348～5.735)mU/L，低龄组分别为1.778( 0.582～4.696)、1.991( 0.427～5.316)mU/L，高龄组TSH水平均较低龄组高(Z＝－2.269、－10.400，均P<0.05)，数据分布较低龄组宽。春、夏、秋3个季节TSH整体分布为1.869( 0.510～5.042)mU/L，冬季为1.978( 0.527～5.250 )mU/L，差异有统计学意义(Z＝－15.000，P<0.001)。 结论： 性别、年龄明显影响TSH、FT4、FT3水平；女性、高龄人群的TSH数据分布更宽，而FT4、FT3数据分布整体较低；季节明显影响TSH水平，冬季出现峰值。初步评估的P(2.5)～P(97.5)数据分布与制造商推荐的参考区间差异较大。各实验室应在适宜分组的前提下建立甲状腺激素的参考区间。.
Keywords: Age; Gender; Reference values; Seasons; Thyrotropin; Thyroxine; Triiodothyronine.