低T3综合征对心力衰竭患者预后影响的Meta分析

Meta-analysis of the effects of low T3 syndrome on the prognosis of patients with heart failure

目的 系统性评价合并低T3综合征对心力衰竭(心衰)患者预后的影响.方法 计算机检索中国知网、万方、维普、中国生物医学文献、Web of Science、EMbase、PubMed数据库,检索时限为建库至2019年3月.按照纳入、排除标准筛选文献,并进行资料提取,采用Newcastle-Ottawa scale(NOS)评价量表对纳入文献进行质量评价.采用RevMan 5.3软件和Stata 14.0软件进行统计分析,计数资料采用相对危险度(RR)及其95%的置信区间(95%CI)为效应分析统计量.结果 共纳入文献7篇,包括心衰患者1832例(低T3综合征组360例,正常甲状腺组1472例).Meta分析显示:在心衰患者中,低T3综合征的患病率为25.0%,95%CI:10.2%~39.7%.与正常甲状腺组相比,低T3综合征是心衰患者全因死亡(RR=1.82,95%CI:1.12~2.97,P=0.02)和心血管死亡(RR=2.13,95%CI:1.43~3.18,P=0.0002)的风险因素.亚组分析显示,低T3综合征是急性心衰患者全因死亡的风险因素(RR=3.94,95%CI:1.40~11.04,P=0.009),而对慢性心衰患者全因死亡无影响(RR=1.03,95%CI:0.66~1.61,P=0.89).结论 低T3综合征在心衰患者中较为常见,并对患者预后具有重要预测价值.另外,患者的心衰类型可能会影响低T3综合征对其预后的预测作用.

Objective To systematically evaluate the effect of low T3 syndrome on the prognosis of patients with heart failure.Methods The databases of CNKI,Wanfang,VIP,CBM,Web of Science,EMbase,PubMed were searched,and the retrieval time was ranged from the foundation of database to March 2019.Literature was screened according to inclusion and exclusion criteria.The relevant data were extracted from included articles,and the quality of the included articles were evaluated using the Newcastle-Ottawa scale(NOS).The RevMan 5.3 software and stata 14.0 software were used for statistical analysis.The relative risk(RR)and 95%confidence interval(95%CI)were used for effect analysis statistics.Results A total of 7 articles were included,including 1832 heart failure patients(360 in the low T3 syndrome group and 1472 in the normal thyroid group).The result of Meta-analysis showed that the prevalence of low T3 syndrome was 25.0%,95%CI:10.2%~39.7%in patients with heart failure.Low T3 syndrome was a risk factor for all-cause mortality(RR=1.82,95%CI:1.12~2.97,P=0.02)and cardiovascular mortality(RR=2.13,95%CI:1.43~3.18,P=0.0002)in patients with heart failure,compared to patients with normal thyroid.Subgroup analysis showed that low T3 syndrome was a risk factor for all-cause mortality in patients with acute heart failure(RR=3.94,95%CI:1.40~11.04,P=0.009),and did not affect the all-cause mortality in patients with chronic heart failure(RR=1.03,95%CI:0.66~1.61,P=0.89).Conclusion Low T3 syndrome is common in patients with heart failure,and has prognostic value to those patients.In addition,the type of heart failure may affect the prognostic effect of low T3 syndrome.