亚临床甲状腺功能减退症与心血管疾病风险因子关系的Meta分析  

Relationship between Subclinical Hypothyroidism and Risk Factors of Cardiovascular Disease:a Meta-analysis

作　　者：王向红 姚克铖 邹秀兰[1] 曾令海[1] 邹琼[1] WANG Xianghong;YAO Kecheng;ZOU Xiulan;ZENG Linghai;ZOU Qiong(Department of Gerontology,the People's Hospital of China Three Gorges University(the First People's Hospital ofYichang),Yichang 443000,China)

机构地区：[1]三峡大学人民医院(宜昌市第一人民医院)老年病科

出　　处：《实用心脑肺血管病杂志》2019年第4期47-52,共6页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：2018年度湖北省卫生健康委员会面上项目(WJ2019M064);2018年度湖北省教育厅人文社会科学研究项目(18D023)

摘　　要：目的评价亚临床甲状腺功能减退症(SCH)与心血管疾病风险因子的关系。方法计算机检索PubMed、EMBase、Web of Science、万方数据知识服务平台、中国知网(CNKI)等数据库,检索时间为2001-01-01至2018-07-30。筛选有关SCH与心血管疾病风险因子关系的病例对照研究,其中甲状腺功能正常受试者作为对照组,SCH患者作为SCH组。采用STATA 12.0软件进行Meta分析。比较两组受试者颈动脉内膜中膜厚度(CIMT)、脉搏波传导速度(PWV)、心外膜脂肪组织(EAT)、血流介导的血管舒张功能(FMD)及硝酸甘油诱导的血管舒张功能(NID)。结果(1)最终纳入27篇文献,共包含1 931例受试者,其中对照组866例、SCH组1 065例;高质量文献22篇。(2)Meta分析结果显示,SCH组患者CIMT〔标准化均数差(SMD)=0.37,95%CI(0.04,0.70),P<0.01〕和EAT〔SMD=1.17,95%CI(0.87,1.47),P<0.01〕厚于对照组,PWV快于对照组〔SMD=3.57,95%CI(0.94,6.21),P=0.008〕,FMD〔SMD=-1.53,95%CI(-2.16,-0.89),P<0.01〕和NID〔SMD=-0.38,95%CI(-0.62,-0.14),P=0.002〕劣于对照组。(3)绘制报道CIMT文献发表偏倚的倒漏斗图发现,散点呈对称分布,发表偏倚的可能性较小。(4)敏感性分析结果显示,依次剔除单个研究后总效应量值无明显变化。结论现有证据表明,SCH与CIMT、PWV、EAT、FMD及NID等心血管疾病风险因子有关,并可导致动脉壁增厚、变硬及内皮细胞功能损伤。Objective To evaluate the relationship between subclinical hypothyroidism(SCH)and risk factors of cardiovascular disease. Methods Computer was used to search databases(such as PubMed,EMBase,Web of Science,Wanfang Data and CNKI)to screen case control studies about relationship between SCH and risk factors of cardiovascular disease from 2001-01-01 to 2018-07-30,thereinto cases with normal thyroid function were served as control group,patients with SCH were served as SCH group. STATA 12.0 software was used to complete this Meta-analysis. Carotid intima media thickness(CIMT),pulse wave velocity(PWV),epicardial adipose tissue(EAT),flow-mediated dilation(FMD)and glyceryl trinitrate(GNT)-induced dilation were compared between the two groups. Results(1)A total of 27 literatures(including 22 literatures with high quality)were enrolled and 1 931 cases were involved(866 cases in control group and 1 065 cases in SCH group).(2)Meta-analysis results showed that,CIMT〔SMD=0.37,95%CI(0.04,0.70),P<0.01〕and EAT〔SMD=1.17,95%CI(0.87,1.47),P<0.01〕in SCH group were statistically significantly thicker that those in control group,PWV in SCH group was statistically significantly faster than that in control group〔SMD=3.57,95%CI(0.94,6.21),P=0.008〕,meanwhile FMD〔SMD=-1.53,95%CI(-2.16,-0.89),P<0.01〕and GNT-induced dilation〔SMD=-0.38,95%CI(-0.62,-0.14),P=0.002〕in SCH group were statistically significantly worse than those in control group.(3)Inverted funnel plot for publication bias of literatures reported CIMT showed that,the scatters were symmetrically distributed,so the publication bias was less likely.(4)Sensitivity analysis results showed that,the total effect magnitude did not obviously change after removing each literature in turn. Conclusion Available evidence suggests that,SCH is significantly correlated with risk factors of cardiovascular disease(such as CIMT,PWV,EAT,FMD and GNT-induced dilation),moreover SCH may result in thickening and hardening of arterial wall,and endothelial cellular impairment.

关 键 词：亚临床甲状腺功能减退症 心血管疾病 颈动脉内膜中膜厚度 脉搏波传导速度 心外膜脂肪组织 内皮细胞功能 META分析 

分 类 号：R581.2[医药卫生—内分泌]