血清游离甲状腺素浓度与心房颤动之间的关联。

Association between serum free thyroxine concentration and atrial fibrillation.

作者信息

Gammage M D, Parle J V, Holder R L, Roberts L M, Hobbs F D R, Wilson S, Sheppard M C, Franklyn J A

机构信息

Department of Cardiovascular Medicine, University of Birmingham, Birmingham, England.

出版信息

Arch Intern Med. 2007 May 14;167(9):928-34. doi: 10.1001/archinte.167.9.928.

DOI:10.1001/archinte.167.9.928

PMID:17502534

Abstract

BACKGROUND

Previous studies have suggested that minor changes in thyroid function are associated with risk of atrial fibrillation (AF). Our objective was to determine the relationship between thyroid function and presence of atrial fibrillation (AF) in older subjects.

METHODS

A population-based study of 5860 subjects 65 years and older, which excluded those being treated for thyroid dysfunction and those with previous hyperthyroidism. Main outcome measures included tests of thyroid function (serum free thyroxine [T(4)] and thyrotropin [TSH]) and the presence of AF on resting electrocardiogram.

RESULTS

Fourteen subjects (0.2%) had previously undiagnosed overt hyperthyroidism and 126 (2.2%), subclinical hyperthyroidism; 5519 (94.4%) were euthyroid; and 167 (2.9%) had subclinical hypothyroidism and 23 (0.4%), overt hypothyroidism. The prevalence of AF in the whole cohort was 6.6% in men and 3.1% in women (odds ratio, 2.23; P<.001). After adjusting for sex, logistic regression showed a higher prevalence of AF in those with subclinical hyperthyroidism compared with euthyroid subjects (9.5% vs 4.7%; adjusted odds ratio, 2.27; P=.01). Median serum free T(4) concentration was higher in those with AF than in those without (1.14 ng/dL; interquartile range [IQR], 1.05-1.27 ng/dL [14.7 pmol/L; IQR, 13.5-16.4 pmol/L] vs 1.10 ng/dL; IQR, 1.00-1.22 ng/dL [14.2 pmol/L; IQR, 12.9-15.7 pmol/L]; P<.001), and higher in those with AF when analysis was limited to euthyroid subjects (1.13 ng/dL; IQR, 1.05-1.26 ng/dL [14.6 pmol/L; IQR, 13.5-16.2 pmol/L] vs 1.10 ng/dL; IQR, 1.01-1.21 ng/dL [14.2 pmol/L; IQR, 13.0-15.6 pmol/L]; P=.001). Logistic regression showed serum free T(4) concentration, increasing category of age, and male sex all to be independently associated with AF. Similar independent associations were observed when analysis was confined to euthyroid subjects with normal TSH values.

CONCLUSIONS

The biochemical finding of subclinical hyperthyroidism is associated with AF on resting electrocardiogram. Even in euthyroid subjects with normal serum TSH levels, serum free T(4) concentration is independently associated with AF.

摘要

背景

既往研究表明，甲状腺功能的微小变化与心房颤动（AF）风险相关。我们的目的是确定老年受试者甲状腺功能与心房颤动（AF）存在之间的关系。

方法

一项基于人群的研究，纳入5860名65岁及以上的受试者，排除正在接受甲状腺功能障碍治疗的患者以及既往有甲状腺功能亢进症的患者。主要结局指标包括甲状腺功能检测（血清游离甲状腺素 [T(4)] 和促甲状腺激素 [TSH]）以及静息心电图上AF的存在情况。

结果

14名受试者（0.2%）既往有未诊断出的显性甲状腺功能亢进症，126名（2.2%）有亚临床甲状腺功能亢进症；5519名（94.4%）甲状腺功能正常；167名（2.9%）有亚临床甲状腺功能减退症，23名（0.4%）有显性甲状腺功能减退症。整个队列中AF的患病率男性为6.6%，女性为3.1%（比值比，2.23；P<.001）。在调整性别后，逻辑回归显示，与甲状腺功能正常的受试者相比，亚临床甲状腺功能亢进症患者中AF的患病率更高（9.5%对4.7%；调整后的比值比，2.27；P = 0.01）。AF患者的血清游离T(4)浓度中位数高于无AF患者（分别为1.14 ng/dL；四分位间距 [IQR]，1.05 - 1.27 ng/dL [14.7 pmol/L；IQR，13.5 - 16.4 pmol/L] 对1.10 ng/dL；IQR，1.00 - 1.22 ng/dL [14.2 pmol/L；IQR，12.9 - 15.7 pmol/L]；P<.001），当分析仅限于甲状腺功能正常的受试者时，AF患者的血清游离T(4)浓度也更高（1.13 ng/dL；IQR，1.05 - 1.26 ng/dL [14.6 pmol/L；IQR，13.5 - 16.2 pmol/L] 对1.10 ng/dL；IQR，1.01 - 1.21 ng/dL [14.2 pmol/L；IQR，13.0 - 15.6 pmol/L]；P = 0.001）。逻辑回归显示，血清游离T(4)浓度、年龄增加以及男性性别均与AF独立相关。当分析仅限于TSH值正常的甲状腺功能正常的受试者时，也观察到了类似的独立关联关系。