BMJ：甲状腺功能“正常”者房颤风险攀升与TSH水平有关

          2012年11月27日，Christian Selmer博士（赫勒乌浦根措夫特大学医院麦）和同事发表《英国医学杂志》的一份对人口基队列研究所作的分析报告显示，心房颤动（AF）新发病风险因甲状腺功能而变，亚临床甲状腺功能亢进者风险明显增加，甚至在低促甲状腺激素（TSH）水平未伴高于正常的游离甲状腺素的情况下也依然如此。这项研究可能是首次对初级保健患者所有甲状腺疾病与并发房颤风险之间相关性进行评估。

         研究结果显示，甲状腺功能障碍和心房颤动新发病风险之间存在TSH水平依赖关系。即使是分散的亚临床甲状腺功能亢进，也会增加心房颤动风险。

         此外，有明显的或亚临床甲状腺功能减退的患者，平均5年随访期间的AF发病风险下降，这是首次显示甲状腺功能减退对心房颤动有保护效应的试验研究。

 

         Anne R Cappola博士（美国宾夕法尼亚大学医学院）赞扬Selmer等人的研究，称他们对未经治疗的亚临床甲状腺功能亢进与房颤风险的相关性进行了说明，但是，目前，还不清楚治疗是否可以逆转这种情况。

To examine the risk of atrial fibrillation in relation to the whole spectrum of thyroid function in a large cohort of patients.

Population based cohort study of general practice patients identified by linkage of nationwide registries at the individual level.

SETTING

Primary care patients in the city of Copenhagen.

Registry data for 586 460 adults who had their thyroid function evaluated for the first time by their general practitioner during 2000-10 and who were without previously recorded thyroid disease or atrial fibrillation.

Poisson regression models used to estimate risk of atrial fibrillation by thyroid function.

Of the 586 460 individuals in the study population (mean (SD) age 50.2 (16.9) years, 39% men), 562 461 (96.0%) were euthyroid, 1670 (0.3%) had overt hypothyroidism, 12 087 (2.0%) had subclinical hypothyroidism, 3966 (0.7%) had overt hyperthyroidism, and 6276 (1.0%) had subclinical hyperthyroidism. Compared with the euthyroid individuals, the risk of atrial fibrillation increased with decreasing levels of thyroid stimulating hormone (TSH) from high normal euthyroidism (incidence rate ratio 1.12 (95% CI 1.03 to 1.21)) to subclinical hyperthyroidism with reduced TSH (1.16 (0.99 to 1.36)) and subclinical hyperthyroidism with supressed TSH (1.41 (1.25 to 1.59)). Both overt and subclinical hypothyroidism were associated with a lower risk of atrial fibrillation.

The risk of atrial fibrillation was closely associated with thyroid activity, with a low risk in overt hypothyroidism, high risk in hyperthyroidism, and a TSH level dependent association with risk of atrial fibrillation across the spectrum of subclinical thyroid disease.