Iervasi Giorgio, Molinaro Sabrina, Landi Patrizia, Taddei Maria Chiara, Galli Elena, Mariani Fabio, L'Abbate Antonio, Pingitore Alessandro
Clinical Physiology Institute, National Council of Research, Via Moruzzi 1, 56124 Pisa, Italy.
Arch Intern Med. 2007 Jul 23;167(14):1526-32. doi: 10.1001/archinte.167.14.1526.
The effects of subclinical thyroid dysfunction on cardiac outcome are not well defined.
To assess the relationship between mild thyroid dysfunction and the incidence of death in cardiac patients, we evaluated 3121 cardiac patients. Cardiac and overall deaths were considered. Four groups were defined: euthyroidism, subclinical hypothyroidism (SCH), subclinical hyperthyroidism (SCT), and low triiodothyronine syndrome (low T3).
After mean follow-up of 32 months, there were 65 and 140 cardiac and overall deaths (3.4% and 7.3%), respectively, in euthyroidism, 15 and 27 (7.2% and 13.0%) in SCH, 8 and 9 (8.2% and 9.2%) in SCT, and 59 and 119 (6.5% and 13.1%) in low T3. Survival rates for cardiac death were lower in SCH, SCT, and low T3 than in euthyroidism (log-rank test; chi2 = 19.46; P < .001). Survival rates for overall death were lower in SCH and low T3 than in euthyroidism (log-rank test; chi2 = 26.67; P < .001). After adjustment for several risk factors, hazard ratios (HRs) for cardiac death were higher in SCH (HR, 2.40; 95% confidence interval [CI], 1.36-4.21; P = .02), SCT (HR, 2.32; 95% CI, 1.11-4.85; P = .02), and low T(3) (HR, 1.63; 95% CI, 1.14-2.33; P = .007) than in euthyroidism; HRs for overall death were higher in SCH (HR, 2.01; 95% CI, 1.33-3.04; P < .001) and low T3 (HR, 1.57; 95% CI, 1.22-2.01; P < .001) but not in SCT.
A mildly altered thyroid status is associated with an increased risk of mortality in patients with cardiac disease.
亚临床甲状腺功能障碍对心脏结局的影响尚不明确。
为评估轻度甲状腺功能障碍与心脏病患者死亡发生率之间的关系，我们对3121例心脏病患者进行了评估。考虑了心脏死亡和全因死亡情况。定义了四组：甲状腺功能正常、亚临床甲状腺功能减退（SCH）、亚临床甲状腺功能亢进（SCT）和低三碘甲状腺原氨酸综合征（低T3）。
平均随访32个月后，甲状腺功能正常组分别有65例和140例心脏死亡和全因死亡（3.4%和7.3%），SCH组有15例和27例（7.2%和13.0%），SCT组有8例和9例（8.2%和9.2%），低T3组有59例和119例（6.5%和13.1%）。SCH、SCT和低T3组的心脏死亡生存率低于甲状腺功能正常组（对数秩检验；χ2 = 19.46；P <.001）。SCH和低T3组的全因死亡生存率低于甲状腺功能正常组（对数秩检验；χ2 = 26.67；P <.001）。在对多个危险因素进行调整后，SCH（风险比[HR]，2.40；95%置信区间[CI]，1.36 - 4.21；P =.02）、SCT（HR，2.32；95% CI，1.11 - 4.85；P =.02）和低T3（HR，1.63；95% CI，1.14 - 2.33；P =.007）组的心脏死亡HR高于甲状腺功能正常组；SCH（HR，2.01；95% CI，1.33 - 3.04；P <.001）和低T3（HR，1.57；95% CI，1.22 - 2.01；P <.001）组的全因死亡HR高于甲状腺功能正常组，但SCT组无差异。
甲状腺状态轻度改变与心脏病患者死亡风险增加相关。
