Park Young Joo, Yoon Ji Won, Kim Kwang Il, Lee You Jin, Kim Kyung Won, Choi Sung Hee, Lim Soo, Choi Dong Ju, Park Kay-Hyun, Choh Joong Haeng, Jang Hak Chul, Kim Seong Yeon, Cho Bo Youn, Lim Cheong
Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Seongnam, Korea.
Ann Thorac Surg. 2009 Jun;87(6):1846-52. doi: 10.1016/j.athoracsur.2009.03.032.
Some studies have proposed that subclinical hypothyroidism (SCH) has adverse effects on the cardiovascular system, but little is known about the effect on patients undergoing cardiovascular operations. We examined the influence of preoperative SCH on postoperative outcome in patients undergoing coronary artery bypass grafting (CABG).
Among patients who underwent CABG between July 2005 and June 2007 at Seoul National University Bundang Hospital, 224 with normal thyroid function and 36 with SCH were enrolled. Preoperative risks and postoperative outcomes were evaluated prospectively without thyroid hormone replacement.
There were no significant differences in primary outcomes (major adverse cardiovascular events) and secondary outcomes such as wound problems, mediastinitis, leg infection, respiratory complications, delirium, or reoperation during the same hospitalization. However, patients with SCH had a higher incidence of postoperative atrial fibrillation than those with normal thyroid function after adjustment for age, gender, body mass index, and other independent variables such as emergency operation, the use of cardiopulmonary bypass, combined valvular operation, preoperative creatinine levels, left ventricular systolic dysfunction, and nonuse of beta-blockers (45.5% vs 29%; odds ratio, 2.552; 95% confidence interval, 1.117 to 5.830; p = 0.026).
SCH appears to influence the postoperative outcome for patients by increasing the development of postoperative atrial fibrillation. However, it is still unproven whether preoperative thyroxine replacement therapy for patients with SCH might prevent postoperative atrial fibrillation after CABG.
一些研究提出亚临床甲状腺功能减退（SCH）对心血管系统有不良影响，但对接受心血管手术患者的影响知之甚少。我们研究了术前SCH对冠状动脉旁路移植术（CABG）患者术后结局的影响。
在2005年7月至2007年6月于首尔国立大学盆唐医院接受CABG的患者中，纳入224例甲状腺功能正常者和36例SCH患者。在不进行甲状腺激素替代治疗的情况下，前瞻性评估术前风险和术后结局。
在同一住院期间，主要结局（主要不良心血管事件）和次要结局如伤口问题、纵隔炎、腿部感染、呼吸并发症、谵妄或再次手术方面无显著差异。然而，在对年龄、性别、体重指数以及其他独立变量如急诊手术、体外循环使用、联合瓣膜手术、术前肌酐水平、左心室收缩功能障碍和未使用β受体阻滞剂进行调整后，SCH患者术后房颤的发生率高于甲状腺功能正常者（45.5%对29%；比值比，2.552；95%置信区间，1.117至5.830；P = 0.026）。
SCH似乎通过增加术后房颤的发生率来影响患者的术后结局。然而，术前对SCH患者进行甲状腺素替代治疗是否可预防CABG术后房颤仍未得到证实。
