Casiglia E, Maschio O, Spolaore P, Colangeli G, Celegon L, Gozzetti S, Beltramello G, Costa F, el Asmar I, Pernice M
Clinica Medica I, Università degli Studi, Padova.
Cardiologia. 1991 Sep;36(9):685-91.
This work was performed in order to evaluate the weight of hyperthyroidism on the genesis of atrial fibrillation in elderly subjects. The data are from the CASTEL (CArdiovascular STudy in the ELderly), an epidemiologic study performed in a town of northern Italy (Castelfranco Veneto), whose 3088 elderly subjects were called and 2254 enrolled for a 7-year intervention trial. From 2224 elderly persons examined in the present study, 90 had atrial fibrillation (AF) as determined by the presence of Minnesota Code 8-3; the other 2134 were used as control population. In the 90 with AF and in the randomly chosen controls, the thyroid function was studied by means of the TRH-test. Taking into consideration an increase of TSH greater than 0.5 or greater than or greater than 1 muUI/ml over the basal value after TRH administration, 5.5% of subjects with atrial fibrillation had a suppressed response (i.e. hyperthyroidism); taking into consideration a peak value of TSH greater than or equal to 2.3 muUI/ml irrespective to the basal value, the prevalence of hyperthyroidism was higher (17.8%), but not different than in control subjects. In conclusion, hyperthyroidism is frequent in elderly subjects but it does not play a role in the pathophysiology of AF. On the contrary, AF may be explained in the majority of cases by concomitant cardiovascular disease, i.e. left atrial enlargement, arterial hypertension, myocardial ischemia, and heart failure.
开展这项研究是为了评估甲状腺功能亢进在老年人心房颤动发生过程中的影响程度。数据来自CASTEL（老年人心血管研究），这是一项在意大利北部一个城镇（威尼斯省卡斯特尔弗兰科）进行的流行病学研究，研究人员给3088名老年人打电话，其中2254人参与了一项为期7年的干预试验。在本研究检查的2224名老年人中，有90人根据明尼苏达编码8 - 3确定患有心房颤动（AF）；另外2134人作为对照人群。对90名患有AF的患者以及随机选择的对照者，通过促甲状腺激素释放激素（TRH）试验研究甲状腺功能。考虑到TRH给药后促甲状腺激素（TSH）较基础值升高大于0.5或大于或大于1微单位/毫升，5.5%的心房颤动患者有抑制反应（即甲状腺功能亢进）；考虑到无论基础值如何TSH峰值大于或等于2.3微单位/毫升，甲状腺功能亢进的患病率更高（17.8%），但与对照者无差异。总之，甲状腺功能亢进在老年人群中很常见，但它在心房颤动的病理生理学中不起作用。相反，在大多数情况下，心房颤动可能由合并的心血管疾病解释，即左心房扩大、动脉高血压、心肌缺血和心力衰竭。
