Eur J Endocrinol:心房颤动患者亚临床甲状腺功能异常与心血管事件发生率的关系

2021-10-22 从医路漫漫 MedSci原创

探讨心房颤动(AF)患者亚临床甲状腺功能障碍与心血管风险的关系。

目的:探讨心房颤动(AF)患者亚临床甲状腺功能障碍与心血管风险的关系。

方法:Swiss-AF是一项对年龄≥65岁的社区居住的房颤患者的前瞻性队列研究。主要结局是心血管事件(心肌梗死、卒中/短暂性缺血事件、全身性栓塞、心衰住院、心血管死亡)的复合终点。次要结果是组成终点、总死亡率和AF进展。暴露于甲状腺功能障碍类别,TSH和FT4。对胺碘酮的使用、甲状腺激素的使用和比赛项目进行敏感性分析。

结果:纳入2415例患者(平均年龄73.2岁;27%的女性)。196例(8.4%)为亚临床甲状腺功能减退,53例(2.3%)为亚临床甲状腺功能亢进。亚临床甲状腺功能障碍与CV事件无关,中位随访时间为2.1年(最大5年):亚临床甲状腺功能减退的年龄和性别校正危险比(调整HR)为0.99(95%可信区间(CI) 0.69-1.41);亚临床甲亢为0.55 (95%CI 0.23-1.32)。经过多变量调整和敏感性分析,结果仍然稳健。在甲状腺正常的患者中,fT4水平与复合终点和HF的风险增加相关(adjHR 1.46 95%CI 1.04- 2.05;调整HR 1.70 95%CI 1.08-2.66,最高五分位相对于中间五分位)。在多变量调整后结果仍然相似。在敏感性分析中,结果对HF仍有重要意义。亚临床甲状腺功能障碍与总死亡率或AF进展之间没有关联。

表1 所有参与者基线时亚临床甲状腺状态导致的心血管事件和全因死亡率

表2 甲状腺功能正常的参与者在基线(n=2004)中的心血管事件和全因死亡率(FT4以五分位数表示)。

图1 在所有正常甲状腺患者中,年龄和性别调整后,FT4每增加5个单位的CV事件发生率

图2 除服用胺碘酮的患者外,年龄和性别调整后,FT4每增加5个单位的CV事件发生率(n=308)

图3 除服用改变甲状腺功能药物外,年龄和性别调整后,FT4每增加5个单位的CV事件发生率(n=175)

结论:亚临床甲状腺功能减退与房颤患者心血管风险增加无关。FT4与正常TSH水平的升高与HF的高风险相关。

原文出处:

Moutzouri E,  Lyko C,  Feller M,et al.Subclinical Thyroid Function and Cardiovascular Events in patients with Atrial Fibrillation.Eur J Endocrinol 2021 Jul 01

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    2021-10-23 sodoo
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    2021-10-22 14757fdfm46暂无昵称

    甲功影响很多方面

    0

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