非甲状腺病态综合征和急性心肌梗死预后相关性的Meta分析

Non-thyroidal Illness Syndrome and the Prognosis of Acute Myocardial Infarction: A Meta Analysis

目的评价非甲状腺病态综合征(NTIS)和急性心肌梗死(AMI)患者近、远期预后的相关性,为判断AMI患者预后提供参考。方法计算机检索PubMed、ISI Web of knowledge、Scopus、Ovid、EMBase、EBSCO、The Cochrane Library、中国生物医学文献服务系统(CBM)、中国知网、万方数据库、中国维普资讯网数据库中关于NTIS和AMI患者的文献,检索时间均为从建立数据库至2013-12-30;补充检索Google Scholar;登录作者主页搜集遗漏、未发表的文献;根据参考文献进行人工检索,弥补缺漏。纳入关于NTIS组和正常甲状腺功能(euthyroid,EU)组患者预后的研究,排除只描述NTIS患者或是分组不明确的研究;效应指标为两组患者近期(30 d及以内)、远期死亡率和严重心血管事件发生率,肾功能损害。由2名研究人员独立评价纳入文献的质量、提取资料。应用Stata/SE 11.0软件选用固定效应模型或随机效应模型进行合并定量分析。结果 5篇文献共纳入2 272例患者,其中NTIS组567例,EU组1 705例。Meta分析结果显示:NTIS组AMI患者和EU组AMI患者比较,发生近期死亡率〔RR=4.33,95%CI(1.59,11.79),P<0.05〕及远期死亡率〔RR=2.71,95%CI(1.28,5.74),P<0.05〕、近期严重心血管事件发生率〔RR=2.38,95%CI(1.77,3.18),P<0.05〕及远期严重心血管事件发生率〔RR=1.91,95%CI(1.25,2.91),P<0.05〕更高,肾功能损害更明显〔标准化均数差(SMD)=0.40,95%CI(0.19,0.61),P<0.05〕。Meta回归分析结果显示,样本量、随访时间、男性比例、校正年龄、纽卡斯尔-渥太华量表(NOS)质量评分与研究异质性的关系均无统计学意义(P>0.05)。Begg检验(Z=1.02,P=0.308)和Egger检验(t=2.08,P=0.172)显示无统计学意义,无发表性偏倚。结论存在NTIS的AMI患者近、远期死亡率和严重心血管事件发生率更高,NTIS患者发生AMI后肾功能损害更严重。

Objective The aim of this meta analysis is to assess the impact of NTIS on the prognosis of patients with a-cute myocardial infarction,providing references for the evaluation of prognosis in AMI patients. Methods The databases〔PubMed,ISI Web of knowledge,Scopus,Ovid,EMBase,EBSCO,The Cochrane Library,CBM,CNKI,Wanfang data-base,VIP database（from established to December 30,2013）〕were systematically searched for literatures on NTIS and AMI;Google Scholar was used as complementary search;log in authors＆#39; homepage searching for some omission or unpublished litera-tures;manual search was conducted according to the reference material. Studies on the subsequent prognosis of NTIS patients and EU patients were included and studies only describing NTIS patients and patients within imprecision groups were excluded. Mortality,severe cardiovascular events＆#39; incidence and renal dysfunction within 30 d or above one year were determined as the effect indictors. 2 researchers independently assessed the quality of the included literatures and extracted relevant materi-als. Quantitative analysis of included literatures was performed by Stata/ SE 11. 0 software,using fixed effect model or random effect model. Results Five literatures,all together 2 272 patients were included in the study,567 in NTIS group and 1 705 in EU group. Meta analysis showed that risk of mortality during 30 days〔 RR = 4. 33,95% CI（1. 59,11. 79）,P 〈 0. 05〕,long term〔RR = 2. 71,95% CI（1. 28,5. 74）,P 〈 0. 05〕,cardiovascular events＆#39; incidence during 30 days〔RR = 2. 38,95% CI （1. 77,3. 18）,P 〈 0. 05〕and long term severe cardiovascular events＆#39; incidence〔RR = 1. 91,95% CI（1. 25,2. 91）,P 〈0. 05〕was found more higher in patients with NTIS than patients with EU. Kidney injury was more serious in NTIS group〔pooled standard mean difference（SMD） = 0. 40,95% CI（0. 19,0. 61）,P 〈 0. 05〕. Meta regression analysis indicated that sam-ple size,follow - up period,male proportion,adjustment of age and NOS quality assessment were not correlated to heterogeneity study（P 〉 0. 05）. Begg test（ Z = 1. 02,P = 0. 308）and Egger test（ t = 2. 08,P = 0. 172）showed no statistic signifi-cance. No published bias was observed. Conclusion NTIS is associated with an increased risk of mortality and adverse cardiovas-cular events,as well as renal dysfunction.