亚临床甲状腺功能减退对心力衰竭患者预后影响的Meta分析

Effects of Subclinical Hypothyroidism on Prognosis of Patients with Heart Failure:a Meta-analysis

背景甲状腺功能与心力衰竭有密切的关系。亚临床甲状腺功能减退已被证明是心力衰竭的危险因素。但对于已经确诊的心力衰竭患者来说,亚临床甲状腺功能减退对其预后有何影响仍然未知。目的系统性评价亚临床甲状腺功能减退对心力衰竭患者预后的影响。方法计算机检索PubMed、Embase、Cochrane Library、中国知网、万方数据知识服务平台、维普网、中国生物医学文献数据库等数据库,搜集国内外发表的亚临床甲状腺功能减退对心力衰竭患者预后影响的队列研究,检索时限均为建库至2020年10月。按照纳入与排除标准筛选文献,并进行资料提取,采用纽卡斯尔-渥太华(NOS)评价量表对纳入文献进行质量评价。采用Stata 14.0统计学软件进行Meta分析,计数资料以风险比(HR)及其95%可信区间(95%CI)为效应量。结果共纳入8篇文献,包括心力衰竭患者9413例(亚临床甲状腺功能减退602例,甲状腺功能正常8811例)。Meta分析结果显示:亚临床甲状腺功能减退是心力衰竭患者全因死亡的风险因素〔HR=1.44,95%CI(1.16,1.78),P<0.05〕。根据研究地区、样本量、年龄、随访时间进行亚组分析,不同亚组分析结果显示,亚临床甲状腺功能减退均是心力衰竭患者全因死亡的风险因素(P<0.05),但在≤65岁和随访时间<2年的心力衰竭中亚临床甲状腺功能减退与全因死亡风险的相关性更强(HR值分别为1.76和2.01)。结论亚临床甲状腺功能减退可能是心力衰竭患者全因死亡的预测因素。但因受纳入研究数量和质量限制,上述结论需要更多高质量的研究予以验证。

Background Thyroid function is closely related to heart failure.Subclinical hypothyroidism has been proven to be a risk factor of heart failure.However,for patients with diagnosed heart failure,subclinical hypothyroidism's impact on prognosis is still unknown.Objective To systematically evaluate the effects of subclinical hypothyroidism on prognosis of patients with heart failure.Methods Computer searched PubMed,Embase,Cochrane Library,CNKI,Wanfang Data Knowledge Service Platform,Weipu.com,China Biomedical Literature Database and the other databases,and collected cohorts published at home and abroad about the impact of subclinical hypothyroidism on prognosis of patients with heart failure for research,the search time limit was from the establishment of the database to October 2020.The literatures were screened according to the inclusion and exclusion criteria,and data was extracted.The Newcastle-Ottawa(NOS)evaluation scale was used to evaluate the quality of the included literature.Meta-analysis was performed using Stata 14.0 statistical software,and the hazard ratio(HR)and its 95%confidence interval(95%CI)were used as the effect value.Results A total of 8 articles were included,including 9413 cases of heart failure patients(602 cases of subclinical hypothyroidism and 8811 cases of normal thyroid function).Meta-analysis results showed that subclinical hypothyroidism was a risk factor for all-cause death in patients with heart failure〔HR=1.44,95%CI(1.16,1.78),P<0.05〕.The subgroup analysis was performed according to the study area,sample size,age,and follow-up time.The results of different subgroups showed that subclinical hypothyroidism was a risk factor for all-cause death in patients with heart failure(P<0.05),and the subclinical hypothyroidism was more closely related to the risk of all-cause death in heart failure patients with≤65 years of age and follow-up time of less than 2 years(HR value was 1.76 and 2.01).Conclusion Subclinical hypothyroidism may be a predictor for all-cause in patients with heart failure.Due to the limited number and quality of included studies,the above conclusions need more high-quality studies to verify.