亚临床甲状腺功能减退症对经皮冠状动脉介入治疗患者临床结局的影响
|
摘要
目的:分析亚临床甲状腺功能减退症(SCH)对经皮冠状动脉介入治疗(PCI)患者术后临床转归的影响。方法:连续入组2012年1月至2017年12月在定安县人民医院诊断并在海南省人民医院心导管室行冠状动脉造影检查并接受PCI治疗的936例冠心病患者。根据促甲状腺激素(TSH)水平,分为甲状腺功能正常组(ET组,n=836)和亚临床甲状腺功能减退症组(SCH组,n=100);SCH组进一步分为两个亚组:SCH组1(TSH 4.5～6.9 mIU/L)和SCH组2(TSH≥7.0 mIU/L)。比较各组之间PCI后不良临床结局(包括非致命性心肌梗死、再次血运重建、心原性死亡以及上述终点的复合心血管事件)的差异,并使用多因素Cox回归分析评估SCH与不良临床结局之间的独立相关性。结果:中位随访321天(170～473天),SCH组心原性死亡(3.0%vs 1.2%,P=0.006)、非致命性心肌梗死(4.0%vs 3.1%,P=0.018)、再次血运重建(17.0%vs 16.1%,P=0.017)和复合心血管事件(20.6%vs 3.0%,P=0.002)的发生率均高于ET组。多因素Cox回归分析显示,SCH与复合心血管事件的风险独立相关(HR=1.52,95%CI:1.04～2.22,P=0.0293)。血清TSH≥7.0 mIU/L与复合心血管事件的风险显著相关(OR=2.07,95%CI:1.28～3.34,P=0.0029)。结论:SCH患者PCI术后预后较差,TSH≥7.0 mIU/L时复合心血管事件风险明显增加。
Objectives: To compare the clinical outcome of coronary heart disease patients with normal TSH(ET) and subclinical hypothyroidism(SCH) after PCI.Methods: This prospective cohort study analyzed the impact of different levels of thyroid stimulating hormone(TSH) on clinical outcomes in patients with coronary heart disease post PCI. All patients were divided into two groups with normal thyroid function(ET group) and subclinical hypothyroidism(SCH group); SCH group was further divided into: SCH group 1(slightly elevated TSH level: 4.5～6.9 mIU/L) and SCH group 2(Intermediate elevation of TSH levels ≥ 7.0 mIU/L). Adverse clinical outcome includes: non-fatal myocardial infarction, revascularization, complex events, cardiogenic death after PCI. The independent correlation between various thyroid hormone levels and adverse clinical outcomes was assessed by multivariate Cox regression analysis.Results: The median follow-up time for all subjects was 321 days(170 to 473 days), the incidences of cardiac death(3.0% vs 1.2%, P=0.006), target vessel revascularization(17.0% vs 16.1%, P=0.017) and composite events(20.6% vs 3.0%, P=0.002) were all significantly higher in the SCH group than those in the ET group. After adjusting for age, sex, smoking, STsegment elevation myocardial infarction, hypertension, diabetes, previous PCI, renal function, left ventricular ejection fraction, B-type natriuretic peptide level, number of implanted stent, total stent length, stent type, obesity and blood lipid, multivariate Cox regression analysis showed that SCH was independently associated with the risk of complex events(OR=1.52, 95% CI:1.04-2.22, P=0.0293. Serum TSH(>7.0 mIU/L) was significantly correlated with the risk of complex events(OR=2.07, 95% CI: 1.28-3.34, P=0.0029).Conclusions: The prognosis after PCI incoronary heart disease patients with SCH is worse than patients with normal thyroid function. TSH>7.0 mIU/L is associated with significantly increased risk of cardiovascular complex events in this patient cohort.
Objectives: To compare the clinical outcome of coronary heart disease patients with normal TSH(ET) and subclinical hypothyroidism(SCH) after PCI.Methods: This prospective cohort study analyzed the impact of different levels of thyroid stimulating hormone(TSH) on clinical outcomes in patients with coronary heart disease post PCI. All patients were divided into two groups with normal thyroid function(ET group) and subclinical hypothyroidism(SCH group); SCH group was further divided into: SCH group 1(slightly elevated TSH level: 4.5～6.9 mIU/L) and SCH group 2(Intermediate elevation of TSH levels ≥ 7.0 mIU/L). Adverse clinical outcome includes: non-fatal myocardial infarction, revascularization, complex events, cardiogenic death after PCI. The independent correlation between various thyroid hormone levels and adverse clinical outcomes was assessed by multivariate Cox regression analysis.Results: The median follow-up time for all subjects was 321 days(170 to 473 days), the incidences of cardiac death(3.0% vs 1.2%, P=0.006), target vessel revascularization(17.0% vs 16.1%, P=0.017) and composite events(20.6% vs 3.0%, P=0.002) were all significantly higher in the SCH group than those in the ET group. After adjusting for age, sex, smoking, STsegment elevation myocardial infarction, hypertension, diabetes, previous PCI, renal function, left ventricular ejection fraction, B-type natriuretic peptide level, number of implanted stent, total stent length, stent type, obesity and blood lipid, multivariate Cox regression analysis showed that SCH was independently associated with the risk of complex events(OR=1.52, 95% CI:1.04-2.22, P=0.0293. Serum TSH(>7.0 mIU/L) was significantly correlated with the risk of complex events(OR=2.07, 95% CI: 1.28-3.34, P=0.0029).Conclusions: The prognosis after PCI incoronary heart disease patients with SCH is worse than patients with normal thyroid function. TSH>7.0 mIU/L is associated with significantly increased risk of cardiovascular complex events in this patient cohort.
引文
[1]Rosario PW.Subclinical hypothyroidism[J].N Engl J Med,2017,377(14):1404.DOI:10.1056/NEJMc1709853.
[2]王恒,李立环,姚允泰,等.亚临床甲状腺功能减退与冠状动脉旁路移植术后患者院内治疗相关性研究[J].中国循环杂志,2016,31(9):870-873.DOI:10.3969/j.issn.1000-3614.2016.09.010.
[3]Quan X,Ji Y,Zhang C,et al.Circulating MiR-146a may be a potential biomarker of coronary heart disease in patients with subclinical hypothyroidism[J].Cell Physiol Biochem,2018,45(1):226-236.DOI:10.1159/000486769.
[4]Rosario PWS,Calsolari MR.Impact of subclinical hypothyroidism with TSH≤10 mIU/L on glomerular filtration rate in adult women without known kidney disease[J].Endocrine,2018,59(3):694-697.DOI:10.1007/s12020-017-1496-x.
[5]López-Tinoco C,Rodríguez-Mengual A,Lara-Barea A,et al.Impact of positive thyroid autoimmunity on pregnant women with subclinical hypothyroidism[J].Endocrinol Diabetes Nutr,2018,65(3):150-155.DOI:10.1016/j.endinu.2017.11.013.
[6]Yadav Y,Saikia UK,Sarma D,et al.Cardiovascular risk factors in children and adolescents with subclinical hypothyroidism[J].Indian J Endocrinol Metab,2017,21(6):823-829.DOI:10.4103/ijem.IJEM_153_17.
[7]Parent S,Cujec B.Subclinical hypothyroidism and heart failure:Chicken or Egg?[J].Can J Cardiol,2018,34(1):11-12.DOI:10.1016/j.cjca.2017.11.016.
[8]Oikawa M,Kobayashi A,Yamaki T,et al.Subclinical hypothyroidism is associated with adverse prognosis in heart failure patients[J].Can J Cardiol,2018,34(1):80-87.DOI:10.1016/j.cjca.2017.10.021.
[9]Gao C,Wang Y,Li T,et al.Effect of subclinical hypothyroidism on the skeletal system and improvement with short-term thyroxine therapy[J].Oncotarget,2017,8(52):90444-90451.DOI:10.18632/oncotarget.19568.
[10]Khan MA,Ahsan T,Rehman UL,et al.Subclinical hypothyroidism:frequency,clinical presentations and treatment indications[J].Pak JMed Sci,2017,33(4):818-822.DOI:10.12669/pjms.334.12921.
[11]Baumgartner C,da Costa BR,Collet TH,et al.Thyroid function within the normal range,subclinical hypothyroidism,and the risk of atrial fibrillation[J].Circulation,2017,136(22):2100-2116.DOI:10.1161/CIRCULATIONAHA.117.028753.
[12]Rastgooye Haghi A,Solhjoo M,Tavakoli MH.Correlation between subclinical hypothyroidism and dyslipidemia[J].Iran J Pathol,2017,12(2):106-111.DOI:10.1161/CIRCULATIONAHA.117.028753.
[13]Nath M,Gupta B,Rai M,et al.Reversal of nocturnal non-dipping of blood pressure after Levothyroxine therapy in patients with subclinical hypothyroidism[J].Diabetes Metab Syndr,2017,11(Suppl 2):S997-S1000.DOI:10.1016/j.dsx.2017.07.028.
[14]Tuliani TA,Shenoy M,Belgrave K,et al.Role of microalbuminuria in predicting cardiovascular mortality in individuals with subclinical hypothyroidism[J].Am J Med Sci,2017,354(3):285-290.DOI:10.1016/j.amjms.2017.04.022.
[15]Pandrc MS,Risti?A,Kostovski V,et al.The effect of early substitution of subclinical hypothyroidism on biochemical blood parameters and the quality of life[J].J Med Biochem,2017,36(2):127-136.DOI:10.1515/jomb-2017-0007.
[16]Decandia F.Risk factors for cardiovascular disease in subclinical hypothyroidism[J].Ir J Med Sci,2018,187(1):39-43.DOI:10.1007/s11845-017-1617-9.
[17]Saric MS,Jurasic MJ,Sovic S,et al.Dyslipidemia in subclinical hypothyroidism requires assessment of small dense low density lipoprotein cholesterol(sdLDL-C)[J].Rom J Intern Med,2017,55(3):159-166.DOI:10.1515/rjim-2017-0015.
[2]王恒,李立环,姚允泰,等.亚临床甲状腺功能减退与冠状动脉旁路移植术后患者院内治疗相关性研究[J].中国循环杂志,2016,31(9):870-873.DOI:10.3969/j.issn.1000-3614.2016.09.010.
[3]Quan X,Ji Y,Zhang C,et al.Circulating MiR-146a may be a potential biomarker of coronary heart disease in patients with subclinical hypothyroidism[J].Cell Physiol Biochem,2018,45(1):226-236.DOI:10.1159/000486769.
[4]Rosario PWS,Calsolari MR.Impact of subclinical hypothyroidism with TSH≤10 mIU/L on glomerular filtration rate in adult women without known kidney disease[J].Endocrine,2018,59(3):694-697.DOI:10.1007/s12020-017-1496-x.
[5]López-Tinoco C,Rodríguez-Mengual A,Lara-Barea A,et al.Impact of positive thyroid autoimmunity on pregnant women with subclinical hypothyroidism[J].Endocrinol Diabetes Nutr,2018,65(3):150-155.DOI:10.1016/j.endinu.2017.11.013.
[6]Yadav Y,Saikia UK,Sarma D,et al.Cardiovascular risk factors in children and adolescents with subclinical hypothyroidism[J].Indian J Endocrinol Metab,2017,21(6):823-829.DOI:10.4103/ijem.IJEM_153_17.
[7]Parent S,Cujec B.Subclinical hypothyroidism and heart failure:Chicken or Egg?[J].Can J Cardiol,2018,34(1):11-12.DOI:10.1016/j.cjca.2017.11.016.
[8]Oikawa M,Kobayashi A,Yamaki T,et al.Subclinical hypothyroidism is associated with adverse prognosis in heart failure patients[J].Can J Cardiol,2018,34(1):80-87.DOI:10.1016/j.cjca.2017.10.021.
[9]Gao C,Wang Y,Li T,et al.Effect of subclinical hypothyroidism on the skeletal system and improvement with short-term thyroxine therapy[J].Oncotarget,2017,8(52):90444-90451.DOI:10.18632/oncotarget.19568.
[10]Khan MA,Ahsan T,Rehman UL,et al.Subclinical hypothyroidism:frequency,clinical presentations and treatment indications[J].Pak JMed Sci,2017,33(4):818-822.DOI:10.12669/pjms.334.12921.
[11]Baumgartner C,da Costa BR,Collet TH,et al.Thyroid function within the normal range,subclinical hypothyroidism,and the risk of atrial fibrillation[J].Circulation,2017,136(22):2100-2116.DOI:10.1161/CIRCULATIONAHA.117.028753.
[12]Rastgooye Haghi A,Solhjoo M,Tavakoli MH.Correlation between subclinical hypothyroidism and dyslipidemia[J].Iran J Pathol,2017,12(2):106-111.DOI:10.1161/CIRCULATIONAHA.117.028753.
[13]Nath M,Gupta B,Rai M,et al.Reversal of nocturnal non-dipping of blood pressure after Levothyroxine therapy in patients with subclinical hypothyroidism[J].Diabetes Metab Syndr,2017,11(Suppl 2):S997-S1000.DOI:10.1016/j.dsx.2017.07.028.
[14]Tuliani TA,Shenoy M,Belgrave K,et al.Role of microalbuminuria in predicting cardiovascular mortality in individuals with subclinical hypothyroidism[J].Am J Med Sci,2017,354(3):285-290.DOI:10.1016/j.amjms.2017.04.022.
[15]Pandrc MS,Risti?A,Kostovski V,et al.The effect of early substitution of subclinical hypothyroidism on biochemical blood parameters and the quality of life[J].J Med Biochem,2017,36(2):127-136.DOI:10.1515/jomb-2017-0007.
[16]Decandia F.Risk factors for cardiovascular disease in subclinical hypothyroidism[J].Ir J Med Sci,2018,187(1):39-43.DOI:10.1007/s11845-017-1617-9.
[17]Saric MS,Jurasic MJ,Sovic S,et al.Dyslipidemia in subclinical hypothyroidism requires assessment of small dense low density lipoprotein cholesterol(sdLDL-C)[J].Rom J Intern Med,2017,55(3):159-166.DOI:10.1515/rjim-2017-0015.