亚临床甲状腺功能减退与慢性收缩性心力衰竭患者预后关系的meta分析

Effect of subclinical hypothyroidism on prognosis of patients with chronic systolic heart failure:A meta-analysis

目的系统性评价亚临床甲状腺功能减退对慢性收缩性心力衰竭患者预后的影响。方法计算机检索Pubmed、Embase、Web of Science、Cochrane Library、中国生物医学文献数据库、中国知网、万方、维普数据库,检索时限为建库至2022年5月,依据纳入排除标准筛选亚临床甲状腺功能减退与慢性收缩性心力衰竭预后关系的文献,提取资料,应用纽卡斯尔-渥太华评价量表(NOS)评价纳入文献的质量。采用Stata 12.0进行统计分析,计数资料采用风险比(HR)及其95%可信区间(95%CI)为效应量。结果共纳入9篇文献,总计21723例慢性收缩性心力衰竭患者(其中亚临床甲状腺功能减退组1225例,甲状腺功能正常组19120例)被纳入meta分析。结果显示:与甲状腺功能正常组相比,亚临床甲状腺功能减退是慢性收缩性心力衰竭患者全因死亡(HR=1.58,95%CI:1.30~1.92)、心脏事件和(或)再住院(HR=1.42,95%CI:1.16~1.73)的风险因素。亚组分析中亦显示亚临床甲状腺功能减退是慢性收缩性心力衰竭患者不良预后的因素。其中,随访时间小于24个月与慢性收缩性心力衰竭全因死亡的相关性最强(HR=2.50),亚洲人群与慢性收缩性心力衰竭心脏事件和(或)再住院风险的相关性最强(HR=1.59)。结论亚临床甲状腺功能减退可能是慢性收缩性心力衰竭患者全因死亡、心血管事件和(或)再住院的风险因素。

Objective To systematically evaluate the effect of subclinical hypothyroidism(SCH)on prognosis of patients with chronic systolic heart failure(CSHF).Methods A computer search was conducted in Web of Science,Cochrane Library,Chinese Biomedical Database(CBM),China National Knowledge Internet(CNKI),Wanfang,VIP database up to May 2022.The literatures regarding SCH-related prognosis of CSHF patients were extracted based on predefined inclusion/exclusion criteria.The Newcastle-Ottawa scale(NOS)was performed to evaluate the relevant data extracted,a Meta-analysis was conducted using STATA 12.0 statistical software,and the hazard ratio(HR)and its 95%confidence interval(95%CI)were used as the effect quantities.Results Eligible 9 literatures representing 21723 CSHF patients(hypothyroidism in 1225;euthyroidism in 19120)were included in the meta-analysis.Meta-analysis results showed that all-cause mortality(HR=1.58,95%CI:1.30-1.92),cardiovascular adverse event and(or)re-hospitalization(HR=1.42,95%CI:1.16-1.73)were risk factors for hypothyroidism as compared to euthyroidism.SCH was associated with poor prognosis of CSHF patients in subgroup analysis.The less than 24 months follow-ups were most strongly associated with all-cause mortality(HR=2.50),Asian CSHF patients were most strongly associated with cardiovascular adverse event and(or)re-hospitalization(HR=1.59).Conclusion SCH might be associated with the risk factors for all-cause mortality,cardiovascular events,and/or hospitalization of CHF patients.