甲状腺功能异常与心室复极化关系的荟萃分析

A Meta-analysis of the relationship between thyroid dysfunction and ventricular repolarization

目的:分析不同甲状腺功能状态对心室复极化的影响。方法:计算机检索PubMed、EMBASE、中国期刊全文数据库、维普数据库、万方数据库于1960~2016-10公开发表的相关文献,用RevMan 5.2软件进行Meta分析,分析不同甲状腺功能状态对于QTc的影响。结果:分析纳入15篇文献、18个病例对照或自身对照研究。Meta分析结果显示,甲亢时QTc较对照组显著延长(MD=18.46,95%CI:10.19~26.73)。甲减患者的QTc较对照组显著延长(MD=29.12,95%CI:15.65~42.60)。甲减患者经过治疗后QTc较治疗前显著缩短(MD=-24.13,95%CI:-30.39^-17.88)。综合纳入的所有研究数据,进一步分析TSH与QT间期的关系,结果示TSH<2.34mIU/L[lg10(TSH)<0.37]时,QTc随着TSH水平的升高而降低,QTc与对数化后的TSH呈负相关(Pearson相关系数r=-0.789,P<0.01;加权线性回归系数R^2=0.622,P<0.01)。TSH>2.34mIU/L时,QTc随着TSH升高而升高,QTc与对数化后的TSH呈正相关(Pearson相关系数r=0.671,P<0.01;加权线性回归系数R^2=0.450,P<0.01)。结论:甲亢和甲减患者的QTc显著延长,甲功异常对于心室复极化有重要影响。

Objective：To find out whether thyroid function has an effect on ventricular repolarization.Methods：PubMed,EMBASE,China National Knowledge Internet（CNKI）,VIP-database and Wanfang Database were searched.Clinical control studies focused on hyperthyroidism or hypothyroidism and ventricular repolarization published between 1960and2016 were collected.RevMan 5.2 was used to perform the Meta-analysis.Results：The Meta-analysis included 15 articles and 18 clinical control studies.Compared to controls,hyperthyroid patients showed a prolonged QTc interval（MD=18.46,95%CI：10.19-26.73）.Compared to controls,hypothyroid patients showed a prolonged QTc interval（MD=29.12,95%CI：15.65-42.60）.After treatments,hypothyroid patients showed a reduced QTc interval（MD=-24.13,95%CI：-30.39--17.88）.Moreover,QTc negatively correlated with the logarithm of TSH levels（Pearson correlation coefficient r=-0.789,P〈0.01;weighted linear regression coefficient R-2=0.622）when TSH 〈2.34mIU/L and positively correlated with the logarithm of TSH levels（Pearson correlation coefficient r=0.671,P〈0.01;weighted linear regression coefficient R-2=0.450）when TSH〉2.34 mIU/L.Conclusion：Both hyperthyroidism and hypothyroidism is associated with ventricular repolarization prolongation.Thyroid dysfunction exerts profound impact on ventricular repolarization.