亚临床甲状腺功能障碍与房颤发生风险相关性的Meta分析  

Subclinical thyroid dysfunction and risk of atrial fibrillation:a meta-analysis

作　　者：向玉萍 罗天会[1,2] 钱永军 曾玲[1,2] XIANG Yuping;LUO Tianhui;QIAN Yongjun;ZENG Ling(Department of Intensive Care Unit,West China Hospital,Sichuan University,Chengdu 610041,P.R.China;West China School of Nursing,Sichuan University,Chengdu 610041,P.R.China;Department of Cardiovascular Surgery,National Clinical Research Center for Geriatrics,West China Hospital,Sichuan University,Chengdu 610041,P.R.China)

机构地区：[1]四川大学华西医院重症医学科,成都610041 [2]四川大学华西护理学院,成都610041 [3]四川大学华西医院心脏大血管外科,国家老年疾病临床医学研究中心,成都610041

出　　处：《中国循证医学杂志》2021年第7期810-815,共6页Chinese Journal of Evidence-based Medicine

摘　　要：目的系统评价亚临床甲状腺功能障碍与房颤发生风险的相关性,以期制定房颤预防策略提供科学依据。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、CNKI、CBM、WanFang Data和VIP数据库,收集亚临床甲状腺功能障碍与房颤风险的队列研究,检索时限均从建库至2020年6月。由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行Meta分析。结果共纳入9个研究,总人数为620874例,其中19781例发生房颤。Meta分析结果显示:与甲状腺正常患者相比,亚临床甲状腺功能减退不会增加房颤的发生风险[RR校正=1.20,95%CI(0.92,1.57),P=0.18],亚临床甲状腺功能亢进会增加房颤的发生风险[RR校正=1.65,95%CI(1.12,2.43),P=0.01]。亚组分析结果显示:在社区人群中,亚临床甲状腺功能减退不会增加房颤发生风险[RR校正=1.03,95%CI(0.84,1.26),P=0.81];但心脏手术患者亚临床甲状腺功能减退会增加房颤发生风险[RR校正=2.80,95%CI(1.51,5.19),P=0.001];当TSH≤0.1 mlU/L[RR校正=2.06,95%CI(1.07,3.99),P=0.03]和TSH值为0.1~0.44 mlU/L[RR校正=1.29,95%CI(1.01,1.64),P=0.04]时,亚临床甲状腺功能亢进均会增加房颤发生风险。结论亚临床甲状腺功能减退不会增加房颤发生风险,但亚临床甲状腺功能亢进会增加房颤发生风险。受纳入研究数量和质量限制,上述结论尚需更多高质量研究予以验证。Objective To systematically review the relationship between subclinical thyroid dysfunction and the risk of atrial fibrillation.Methods Databases including PubMed,EMbase,The Cochrane Library,Web of Science,CNKI,CBM,VIP and WanFang Data were electronically searched to collect cohort studies on associations between subclinical thyroid dysfunction and atrial fibrillation from inception to June 2020.Two reviewers independently screened literature,extracted data,and evaluated risk of bias of included studies.Meta-analysis was then performed using RevMan 5.3 software.Results A total of 11 studies involving 620874 subjects and 19781 cases were included.Meta-analysis showed that subclinical hypothyroidism was not associated with atrial fibrillation(adjusted RR=1.20,95%CI 0.92 to 1.57,P=0.18)and subclinical hyperthyroidism could increase the risk of atrial fibrillation(adjusted RR=1.65,95%CI 1.12 to 2.43,P=0.01).Subgroup analysis showed that for the community population,subclinical hypothyroidism was not associated with atrial fibrillation(adjusted RR=1.03,95%CI 0.84 to 1.26,P=0.81);for cardiac surgery,subclinical hypothyroidism could increase the risk of atrial fibrillation(adjusted RR=2.80,95%CI 1.51 to 5.19,P=0.001);subclinical hyperthyroidism could increase the risk of atrial fibrillation among patients with TSH≤0.1 mlU/L(adjusted RR=2.06,95%CI 1.07 to 3.99,P=0.03)and TSH=0.1~0.44 mlU/L(adjusted RR=1.29,95%CI 1.01 to 1.64,P=0.04).Conclusions Subclinical hypothyroidism is not associated with atrial fibrillation and subclinical hyperthyroidism can increase the risk of atrial fibrillation.Due to limited quantity and quality of included studies,more high quality studies are needed to verify above conclusions.

关 键 词：亚临床甲状腺功能减退 亚临床甲状腺功能亢进 房颤 相关性 META分析 

分 类 号：R581.2[医药卫生—内分泌] R541.75[医药卫生—内科学]