心外科术前甲状腺功能减退与术后早期恢复和并发症相关性的Meta分析

Meta analysis of the relationship between preoperative hypothyroidism and postoperative early recovery/complications after cardiac surgery

目的应用Meta分析的方法评价甲状腺功能减退(甲减)与心外科术后早期恢复和并发症的相关性。方法计算机检索PubMed,Embase,Cochrane图书馆,中国学术期刊全文数据库(CNKI)、中国生物医学文献数据光盘数据库(CBM disc)及维普数据库(VIP)里的心外科患者术前合并甲减的观察性研究。文献检索时间从建库至2020年12月。根据The Newcastle-Ottawa Scale(NOS)量表评价纳入文献的质量并提取资料。对符合质量标准的研究采用Rev Man 5.3进行异质性检验及Meta分析。结果检出相关文献106篇,根据纳入标准最终入选5篇文献;共入选病例5797例,心外科术前甲减总的发生率为16.61%。与甲状腺功能正常患者相比,合并甲减患者的术后围术期死亡率(OR=1.46,95%CI:0.62~3.44,P=0.39)、术后早期卒中发生率(OR=1.49,95%CI:0.59~3.78,P=0.40)无明显差异;合并甲减患者在围术期心肌梗死(OR=1.43,95%CI:1.05~1.96,P=0.03)、术后早期急性肾功能不全(OR=1.86,95%CI:1.03~3.36,P=0.04)的发生率、ICU时间(SMD=0.13,95%CI:0.04~0.22,P=0.004)和术后住院时间(SMD=0.12,95%CI:0.03~0.21,P=0.009)均较甲状腺功能正常患者明显增加,差异均有统计学意义。两组患者术后心房颤动(房颤)发生率(OR=1.60,95%CI:0.84~3.06,P=0.15)无明显差异,但在以冠状动脉粥样硬化性心脏病(冠心病)为主的人群中,合并甲减患者的术后房颤发生率(OR=2.01,95%CI:1.51~2.69,P<0.01)要高于甲状腺功能正常患者。结论心外科患者术前合并甲减与术后早期并发症的风险增加相关,并增加ICU时间和术后住院时间。尚需大规模前瞻性研究确定甲减与心外科术后近远期预后的影响。

Objectives The purpose of this study was to conduct a meta-analysis of published studies evaluating the relationship between preoperative hypothyroidism and postoperative early recovery/complications of cardiac surgery.Methods The observational study of preoperative hypothyroidism in cardiac surgery patients in PubMed,EMBASE,Cochrane Library,Chinese academic journal full-text database(CNKI),Chinese biomedical literature data disc database(CBM disc)and VIP database was searched by computer.The document retrieval time is from the establishment of the database to December 2020.The quality of the included literature was evaluated according to the Newcastle Ottawa scale(NOS),and the data were extracted.For the studies meeting the quality standards,Rev man 5.3 was used for heterogeneity test and meta-analysis.Results Of 106 studies identified,5 studies met eligibility criteria and included a total of 5797 patients.The total incidence of hypothyroidism before cardiac surgery was 16.61%.There were no significant differences in perioperative mortality(OR=1.46,95%CI:0.62~3.44,P=0.39)and early postoperative stroke(OR=1.49,95%CI:0.59~3.78,P=0.40)between patients with hypothyroidism and with normal thyroid function.Compared with the patients with normal thyroid function,the patients with hypothyroidism had significantly increased perioperative myocardial infarction(OR=1.43,95%CI:1.05~1.96,P=0.03),early postoperative acute renal failure(OR=1.86,95%CI:1.03~3.36,P=0.04),ICU time(SMD=0.13,95%CI:0.04~0.22,P=0.004)and postoperative hospital stay(SMD=0.12,95%CI:0.03~0.21,P=0.009).There was no significant difference in the inCIdence of postoperative atrial fibrillation between the two groups(OR=1.60,95%CI:0.84~3.06,P=0.15),but in patients with coronary heart disease,the incidence of postoperative atrial fibrillation in patients with hypothyroidism(OR=2.01,95%CI:1.51~2.69,P<0.01)was higher than that in patients with normal thyroid function.Conclusions Preoperative hypothyroidism in cardiac surgery is associated with an increased risk of early postoperative complications and increased ICU time and postoperative hospital stay.Large scale prospective studies are needed to determine the impact of hypothyroidism on short-and long-term prognosis after cardiac surgery.