亚临床甲状腺功能异常与骨折风险相关性的meta分析  

Relationship between the subclinical thyroid dysfunction and the risk for fracture： A meta analysis

作　　者：徐金玲[1] 向光大[1] 赵林双[1] 乐岭[1] 

机构地区：[1]广州军区武汉总医院内分泌科,430070

出　　处：《中华内分泌代谢杂志》2017年第2期103-110,共8页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的评估亚临床甲状腺功能紊乱与骨折风险的关系。方法计算机检索Medline、Embase、Pubmed、Cochrane Library、中国生物医学数据服务系统、万方数据知识服务平台、中国知网数据出版平台、维普期刊资源整合服务平台等数据库，收集1990年1月至2015年8月公开发表的有关亚临床甲状腺功能异常和骨折相关性的前瞻性队列研究，剔除不符合要求的文献，根据人选文献的同质性检验结果进行数据合并，计算合并RR值，应用Stata13．0软件进行meta分析。结果共纳入9个前瞻性队列研究，最终有292460名参与者。与甲状腺功能正常者相比较，亚临床甲状腺功能亢进症（亚甲亢）患者发生骨折风险高（RR=1．39，95％CI1．24～1．55），以髋部骨折、非脊柱骨折较明显（髋部RR=1．24，95％CI1．10～1．40：非脊柱RR=1．32，95％C11．09～1．60）；不同性别亚甲亢患者中，无论女性或是男性发生骨折风险均增高（女性RR=1．15，95％CI1．04～1．27；男性1．31，95％CI1．08—1．59）。将亚甲亢患者按随访时间亚组分析发现，整个随访期间亚甲亢患者骨折发生风险均升高。亚临床甲状腺功能减退症（亚甲减）患者发生骨折的RR为1．21（95％C11．03～1．42），其中非脊柱骨折RR为2．67（95％C11．38～5．16），而亚甲减对髋部骨折的发生无明显影响（P〉0．05）；按性别亚组分析发现，男性亚甲减患者更易发生骨折（RR=1．09，95％C11．03—1．15）；根据随访时间亚组分析，中位随访时间5年以内或10年以上的亚甲减患者发生骨折RR分别为1．44（95％CI1．15～1．80）、1．27（95％CI1．15—1．41）。内源性及外源性亚甲亢发生骨折风险均较高（内源性RR=1．26，95％C11．08～1．47；外源性RR=1．4，95％C11．2～1．63）；内源性及外源性亚甲减与骨折发生风险无明显相关性。结论亚甲亢与患者髋部、非脊柱Objective To assess the association of subclinical thyroid dysfunction with fractures. Methods Medline, Embase, Pubmed, Cochrane Library, CBM, CNKI, Wan Fang, and VIP databases were systematically searched from January 1990 to August 2015 to identify prospective cohort studies which have studied the risk of fracture in patients with subclinical thyroid dysfunction. The relative risks （RR） of cohort studies were pooled respectively, depending on the result of heterogeneity test among the individual studies search. The Stata （ version 13.0 ） software was used for recta-analysis. Results Nine prospective cohort studies including 292 460 participants were identified as eligible for the recta-analysis. RR of subclinical hyperthyroidism for fracture was 1.39（95% CI 1.24-1.55 ） ; for hip fracture, RR was 1.24（95% CI 1.10-1.40） ; for nonspine fracture, RR was 1.32 （95% CI 1.09-1.60）. Different gender for subclinical hyperthyroid was associated with higher fracture rates ： for females, RR was 1.15 （ 95 % CI 1.04- 1.27） ; for males, RR was 1. 31 （95% CI 1.08-1.59 ）. The incidence of fracture in patients with subclinical hyperthyroidism was higher during the follow-up. For subclinical hypothyroidism, the RR was 1.21 （95% C1 1.03- 1.42 ）. Subgroup analysis indicated that there were significant differences between endogenous/exogenous subclinical hyperthyroidism and euthyroid, but no differences between endogenous/exogenous subclinical hypothyroidism and euthyroid were found. Conclusion Subclinical hyperthyroidism is associated with an increased risk of fracture in the population, especially hip fracture and nonspine fracture. During the course of subclinical hyperthyroidism, the incidences of fracture should be noticed both in females and males. However, there is no evidence which could prove a definite association between subclinical hypothyroidism and the risk of fracture.

关 键 词：亚临床甲状腺功能亢进症 亚临床甲状腺功能减退症 骨折 

分 类 号：R581[医药卫生—内分泌] R683[医药卫生—内科学]