冠心病与亚临床甲状腺功能减退之间的关系：一项血管造影研究。
Relationship between coronary disease and subclinical hypothyroidism: an angiographic study.
作者信息
Fiarresga António José, Feliciano Joana, Fernandes Rita, Martins Andreia, Pelicano Nuno, Timóteo Ana Teresa, Ferreira Rui Cruz
机构信息
Serviço de Cardiologia, Hospital de Santa Marta, Lisboa, Portugal.
出版信息
Rev Port Cardiol. 2009 May;28(5):535-43.
INTRODUCTION
The definition of subclinical hypothyroidism (SH) is an asymptomatic state in which free thyroxine (T4) is normal and thyroid-stimulating hormone (TSH) levels are elevated. Its relationship with coronary disease is not clear and has been the subject of recent interest. Current evidence is conflicting and there is a lack of studies supported by coronary angiography.
OBJECTIVE
To assess the relationship between SH and the presence and extent of coronary disease diagnosed by angiography.
METHODS
We prospectively studied 354 consecutive patients referred for elective coronary angiography. Those with known thyroid disease, documented coronary disease or previous myocardial infarction were excluded. Fasting blood specimens were collected to measure thyroid hormones, lipid profile, high-sensitivity C-reactive protein, fibrinogen and NT-proBNP. Patients with SH were compared with those without to assess differences in clinical characteristics and biochemical and angiographic results. Significant coronary disease was defined as the presence of at least one lesion with > or = 50% luminal stenosis. Lesions with <50% stenosis were considered minimal.
RESULTS
SH was diagnosed in 32 (9%) patients. Mean age was similar between the groups. There were more women (66% vs. 39%; p=0.003) and atrial fibrillation was more frequent (25% vs. 11%; p=0.016) in the group of patients with SH. There were no significant differences in the other baseline clinical parameters, and blood biochemistry results were similar in the two groups, with the exception of higher levels of NT-proBNP in SH patients, although without statistical significance. The angiographic results were as follows: significant coronary disease (SH 28.1% vs. non-SH 43.8%; p=0.087); three-vessel disease (9.4% vs. 9.9%; p=0.919); two-vessel disease (12.5% vs. 13.4%; p=0.892); single-vessel disease (6.3% vs. 29.5%; p=0.051); minimal lesions (9.4% vs. 10.9%; p=0.794); and no coronary disease (62.4% vs, 45.3%; p=0.064).
CONCLUSION
In this population SH was not associated with the presence or extent of coronary disease diagnosed by coronary angiography.
引言
亚临床甲状腺功能减退（SH）的定义是一种无症状状态，其中游离甲状腺素（T4）正常而促甲状腺激素（TSH）水平升高。其与冠心病的关系尚不清楚，且一直是近期关注的主题。目前的证据相互矛盾，并且缺乏冠状动脉造影支持的研究。
目的
评估SH与经血管造影诊断的冠心病的存在及程度之间的关系。
方法
我们对354例连续接受选择性冠状动脉造影的患者进行了前瞻性研究。排除患有已知甲状腺疾病、有记录的冠心病或既往心肌梗死的患者。采集空腹血标本以测量甲状腺激素、血脂、高敏C反应蛋白、纤维蛋白原和NT-脑钠肽前体。将SH患者与非SH患者进行比较，以评估临床特征、生化及血管造影结果的差异。显著冠心病定义为存在至少一处管腔狭窄≥50%的病变。狭窄<50%的病变被视为轻度病变。
结果
32例（9%）患者被诊断为SH。两组患者的平均年龄相似。SH患者组中女性更多（66%对39%；p=0.003），心房颤动更常见（25%对11%；p=0.016）。其他基线临床参数无显著差异，两组血液生化结果相似，但SH患者的NT-脑钠肽前体水平较高，尽管无统计学意义。血管造影结果如下：显著冠心病（SH组28.1%对非SH组43.8%；p=0.087）；三支血管病变（9.4%对9.9%；p=0.919）；两支血管病变（12.5%对13.4%；p=0.892）；单支血管病变（6.3%对29.5%；p=0.051）；轻度病变（9.4%对10.9%；p=0.794）；无冠心病（62.4%对45.3%；p=0.064）。
结论
在该人群中，SH与经冠状动脉造影诊断的冠心病的存在及程度无关。
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