甲状腺功能在正常范围内、亚临床甲状腺功能减退与心房颤动风险
Thyroid Function Within the Normal Range, Subclinical Hypothyroidism, and the Risk of Atrial Fibrillation.
作者信息
Baumgartner Christine, da Costa Bruno R, Collet Tinh-Hai, Feller Martin, Floriani Carmen, Bauer Douglas C, Cappola Anne R, Heckbert Susan R, Ceresini Graziano, Gussekloo Jacobijn, den Elzen Wendy P J, Peeters Robin P, Luben Robert, Völzke Henry, Dörr Marcus, Walsh John P, Bremner Alexandra, Iacoviello Massimo, Macfarlane Peter, Heeringa Jan, Stott David J, Westendorp Rudi G J, Khaw Kay-Tee, Magnani Jared W, Aujesky Drahomir, Rodondi Nicolas
机构信息
Department of General Internal Medicine, Inselspital, Bern University Hospital, (C.B., M.F., C.F., D.A., N.R.).
Institute of Primary Health Care (BIHAM) (B.R.d.C., M.F., N.R.).
出版信息
Circulation. 2017 Nov 28;136(22):2100-2116. doi: 10.1161/CIRCULATIONAHA.117.028753. Epub 2017 Oct 23.
BACKGROUND
Atrial fibrillation (AF) is a highly prevalent disorder leading to heart failure, stroke, and death. Enhanced understanding of modifiable risk factors may yield opportunities for prevention. The risk of AF is increased in subclinical hyperthyroidism, but it is uncertain whether variations in thyroid function within the normal range or subclinical hypothyroidism are also associated with AF.
METHODS
We conducted a systematic review and obtained individual participant data from prospective cohort studies that measured thyroid function at baseline and assessed incident AF. Studies were identified from MEDLINE and EMBASE databases from inception to July 27, 2016. The euthyroid state was defined as thyroid-stimulating hormone (TSH) 0.45 to 4.49 mIU/L, and subclinical hypothyroidism as TSH 4.5 to 19.9 mIU/L with free thyroxine (fT4) levels within reference range. The association of TSH levels in the euthyroid and subclinical hypothyroid range with incident AF was examined by using Cox proportional hazards models. In euthyroid participants, we additionally examined the association between fT4 levels and incident AF.
RESULTS
Of 30 085 participants from 11 cohorts (278 955 person-years of follow-up), 1958 (6.5%) had subclinical hypothyroidism and 2574 individuals (8.6%) developed AF during follow-up. TSH at baseline was not significantly associated with incident AF in euthyroid participants or those with subclinical hypothyroidism. Higher fT4 levels at baseline in euthyroid individuals were associated with increased AF risk in age- and sex-adjusted analyses (hazard ratio, 1.45; 95% confidence interval, 1.26-1.66, for the highest quartile versus the lowest quartile of fT4; for trend ≤0.001 across quartiles). Estimates did not substantially differ after further adjustment for preexisting cardiovascular disease.
CONCLUSIONS
In euthyroid individuals, higher circulating fT4 levels, but not TSH levels, are associated with increased risk of incident AF.
背景
心房颤动（AF）是一种高度流行的疾病，可导致心力衰竭、中风和死亡。加强对可改变风险因素的认识可能带来预防机会。亚临床甲状腺功能亢进会增加房颤风险，但甲状腺功能在正常范围内的变化或亚临床甲状腺功能减退是否也与房颤有关尚不确定。
方法
我们进行了一项系统评价，并从在基线测量甲状腺功能并评估房颤发生率的前瞻性队列研究中获取个体参与者数据。从MEDLINE和EMBASE数据库中检索从创建到2016年7月27日的研究。甲状腺功能正常状态定义为促甲状腺激素（TSH）0.45至4.49 mIU/L，亚临床甲状腺功能减退定义为TSH 4.5至19.9 mIU/L且游离甲状腺素（fT4）水平在参考范围内。使用Cox比例风险模型检查甲状腺功能正常和亚临床甲状腺功能减退范围内的TSH水平与房颤发生率之间的关联。在甲状腺功能正常的参与者中，我们还检查了fT4水平与房颤发生率之间的关联。
结果
在来自11个队列的30085名参与者（278955人年的随访）中，1958人（6.5%）患有亚临床甲状腺功能减退，2574人（8.6%）在随访期间发生房颤。在甲状腺功能正常的参与者或亚临床甲状腺功能减退的参与者中，基线TSH与房颤发生率无显著关联。在年龄和性别调整分析中，甲状腺功能正常个体的基线fT4水平较高与房颤风险增加相关（风险比，1.45；95%置信区间，1.26 - 1.66，fT4最高四分位数与最低四分位数相比；四分位数间趋势≤0.001）。在进一步调整既往心血管疾病后，估计值无实质性差异。
结论
在甲状腺功能正常的个体中，循环fT4水平较高而非TSH水平与房颤发生风险增加相关。
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