甲状腺功能减退与房颤发生风险关系的Meta分析

Hypothyroidism and risk of atrial fibrillation: a meta-analysis

目的系统评价甲状腺功能减退与房颤发生风险的关系。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、CNKI、CBM、VIP和WanFang Data数据库,搜集国内外发表的甲状腺功能减退与房颤发生关系的队列研究和病例-对照研究,检索时限均为建库至2019年11月。由2名研究者独立筛选文献、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5个队列研究,包括574 268例患者,累计发生房颤18 059例。Meta分析结果显示:与甲状腺功能正常人群相比,甲状腺功能减退人群不会增加房颤的发生风险[OR=1.10,95%CI(0.75,1.61),P=0.62];亚组Meta分析结果显示:与甲状腺功能正常人群相比,甲状腺功能减退不会增加社区人群[OR=0.97,95%CI(0.72,1.29),P=0.82]及心脏术后患者[OR=1.22,95%CI(0.58,2.53),P=0.60]的房颤发生风险。结论当前证据显示,甲状腺功能减退不会增加房颤的发生风险。受纳入研究数量和质量限制,上述结论尚待更多高质量研究予以验证。

Objectives To systematically review the relationship between hypothyroidism and the risk of atrial fibrillation. Method PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, VIP and WanFang Data databases were electronically searched to collect cohort and case-control studies on the association between hypothyroidism and atrial fibrillation from inception to November 2019. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software. Results A total of 5 cohort studies involving 574 268 subjects and 18 059 atrial fibrillation cases were included.The results of meta-analysis showed that hypothyroidism was not associated with atrial fibrillation(OR=1.10, 95%CI 0.75 to 1.61, P=0.62). From subgroup analysis, no relationship was identified in community population(OR=0.97, 95%CI 0.72 to 1.29, P=0.82) and cardiac surgery patients(OR=1.22, 95%CI 0.58 to 2.53, P=0.60). Conclusions Hypothyroidism does not increase the risk of atrial fibrillation. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusions.