Heart:Graves'病患者心衰发生率、危险因素、病程和结局

2021-09-14 MedSci原创 MedSci原创

5.4%的GD患者发生新发HF,并且与心血管住院和死亡风险增加相关,其危险因素包括房颤、较高的TRAb、较高的BMI和明显的甲状腺功能亢进。

Graves'病(GD)既可加重原有心脏病,又可导致新发心力衰竭(HF),但缺乏大型研究。近日,心脏病领域权威杂志Heart上发表了一篇研究文章,研究人员旨在调查与GD相关的HF的发生率、危险因素和结局。

 
该研究回顾性地纳入了GD(2009-2019)患者。射血分数降低(HFrEF)的心衰定义为左心室射血分数<50%和符合Framingham标准,而射血分数正常的心衰(HFpEF)定义为符合HFA-PEFF标准。研究人员排除了因缺血、瓣膜疾病或其他结构性心脏病引起的HF,并使用比例风险回归分析危险因素和结局。

在1371名GD患者中,74名(5.4%)患者发生HF(31(2.3%)名HFrEF;43(3.1%)名HFpEF)。在HFrEF患者中,心房颤动(AF)(HR为10.5(3.0–37.3),p<0.001)和促甲状腺激素受体抗体(TRAb)水平(HR为1.05(1.01–1.09)/单位,p=0.007)是独立的危险因素。

在HFpEF患者中,独立危险因素包括慢性阻塞性肺疾病(HR为7.2(3.5-14.6),p<0.001)、年龄较大(每10岁HR为1.5(1.2-2.0),p=0.001)、明显甲状腺功能亢进(HR为6.4(1.5–27.1),p=0.01)、较高的体重指数(BMI)(每单位HR为1.07(1.03–1.10),p=0.001)和高血压(HR为3.1(1.3–7.2),p=0.008)。HFrEF(HR为10.3(5.5-19.4),p<0.001)和HFpEF(HR为6.7(3.7-12.2),p<0.001)的血管住院风险较高。然而,只有HFrEF与全因死亡率(HR为5.17(1.3-19.9),p=0.02)和室性心动过速/颤动(HR为64.3(15.9-259.7),p<0.001)的风险增加相关。
 
由此可见,5.4%的GD患者发生新发HF,并且与心血管住院和死亡风险增加相关,其危险因素包括房颤、较高的TRAb、较高的BMI和明显的甲状腺功能亢进。

原始出处:

Jwan A Naser.et al.Incidence, risk factors, natural history and outcomes of heart failure in patients with Graves’ disease.heart.2021.https://heart.bmj.com/content/early/2021/09/06/heartjnl-2021-319752

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    2021-10-04 1def6e10m76(暂无匿称)

    #心衰#5.4%的GD患者发生新发HF,并且与心血管住院和死亡风险增加相关,其危险因素包括房颤、较高的TRAb、较高的BMI和明显的甲状腺功能亢进。

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1826727, encodeId=91a61826e27ec, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Mon Mar 14 01:55:46 CST 2022, time=2022-03-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2039606, encodeId=d9f8203960650, content=<a href='/topic/show?id=7ae88244a6' target=_blank style='color:#2F92EE;'>#Graves#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8244, encryptionId=7ae88244a6, topicName=Graves)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Tue Sep 28 18:55:46 CST 2021, time=2021-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057405, encodeId=f310105e405a1, content=<a href='/topic/show?id=f5cb5192610' target=_blank style='color:#2F92EE;'>#心衰#</a>5.4%的GD患者发生新发HF,并且与心血管住院和死亡风险增加相关,其危险因素包括房颤、较高的TRAb、较高的BMI和明显的甲状腺功能亢进。, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51926, encryptionId=f5cb5192610, topicName=心衰)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 09:07:48 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357785, encodeId=ec76135e7850a, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Sep 16 08:55:46 CST 2021, time=2021-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563521, encodeId=a2d1156352128, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Sep 16 08:55:46 CST 2021, time=2021-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1051268, encodeId=a1fe1051268e6, content=学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7a485472875, createdName=ms2000000982990246, createdTime=Tue Sep 14 21:08:40 CST 2021, time=2021-09-14, status=1, ipAttribution=)]
    2021-09-16 zhaojie88
  5. [GetPortalCommentsPageByObjectIdResponse(id=1826727, encodeId=91a61826e27ec, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Mon Mar 14 01:55:46 CST 2022, time=2022-03-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2039606, encodeId=d9f8203960650, content=<a href='/topic/show?id=7ae88244a6' target=_blank style='color:#2F92EE;'>#Graves#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8244, encryptionId=7ae88244a6, topicName=Graves)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Tue Sep 28 18:55:46 CST 2021, time=2021-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057405, encodeId=f310105e405a1, content=<a href='/topic/show?id=f5cb5192610' target=_blank style='color:#2F92EE;'>#心衰#</a>5.4%的GD患者发生新发HF,并且与心血管住院和死亡风险增加相关,其危险因素包括房颤、较高的TRAb、较高的BMI和明显的甲状腺功能亢进。, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51926, encryptionId=f5cb5192610, topicName=心衰)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 09:07:48 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357785, encodeId=ec76135e7850a, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Sep 16 08:55:46 CST 2021, time=2021-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563521, encodeId=a2d1156352128, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Sep 16 08:55:46 CST 2021, time=2021-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1051268, encodeId=a1fe1051268e6, content=学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7a485472875, createdName=ms2000000982990246, createdTime=Tue Sep 14 21:08:40 CST 2021, time=2021-09-14, status=1, ipAttribution=)]
    2021-09-16 slcumt
  6. [GetPortalCommentsPageByObjectIdResponse(id=1826727, encodeId=91a61826e27ec, content=<a href='/topic/show?id=e5283e89970' target=_blank style='color:#2F92EE;'>#发生率#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=37899, encryptionId=e5283e89970, topicName=发生率)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=30bd35, createdName=一叶知秋, createdTime=Mon Mar 14 01:55:46 CST 2022, time=2022-03-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2039606, encodeId=d9f8203960650, content=<a href='/topic/show?id=7ae88244a6' target=_blank style='color:#2F92EE;'>#Graves#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8244, encryptionId=7ae88244a6, topicName=Graves)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4dfa37, createdName=智者为医08, createdTime=Tue Sep 28 18:55:46 CST 2021, time=2021-09-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1057405, encodeId=f310105e405a1, content=<a href='/topic/show?id=f5cb5192610' target=_blank style='color:#2F92EE;'>#心衰#</a>5.4%的GD患者发生新发HF,并且与心血管住院和死亡风险增加相关,其危险因素包括房颤、较高的TRAb、较高的BMI和明显的甲状腺功能亢进。, beContent=null, objectType=article, channel=null, level=null, likeNumber=78, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51926, encryptionId=f5cb5192610, topicName=心衰)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTInOuicIVN8Y32NO4Q53Zpd86ObmNp2WIotichCD0qQHaUBeHj7hgwQBCzX7ce4aEw5ZP8icQQfLH9Zw/132, createdBy=4ec21734756, createdName=1def6e10m76(暂无匿称), createdTime=Mon Oct 04 09:07:48 CST 2021, time=2021-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1357785, encodeId=ec76135e7850a, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Thu Sep 16 08:55:46 CST 2021, time=2021-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1563521, encodeId=a2d1156352128, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Thu Sep 16 08:55:46 CST 2021, time=2021-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1051268, encodeId=a1fe1051268e6, content=学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7a485472875, createdName=ms2000000982990246, createdTime=Tue Sep 14 21:08:40 CST 2021, time=2021-09-14, status=1, ipAttribution=)]
    2021-09-14 ms2000000982990246

    学到很多

    0

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