Department of Endocrinology, Gateshead Health National Health Service Foundation Trust, Gateshead NE9 6SX, United Kingdom.
J Clin Endocrinol Metab. 2010 Apr;95(4):1734-40. doi: 10.1210/jc.2009-1749. Epub 2010 Feb 11.
The Whickham Survey evaluated vascular events over 20 yr in community-dwelling subjects stratified by thyroid function and thyroid autoantibody status. No association between ischemic heart disease (IHD) and a composite autoimmune thyroid disease group, comprising individuals with subclinical hypothyroidism (SCH), with positive thyroid antibodies or those using levothyroxine, was found. This result appears to be at odds with the findings of other cohort studies.
The objective of the study was to evaluate incident IHD and mortality in participants in relation to their thyroid status. OUTCOMES, DESIGN, AND PARTICIPANTS: Data were reanalyzed assessing incident IHD events and mortality during 20 yr of follow-up in individuals with endogenous SCH (n = 97; TSH 6.0-15 mIU/liter) vs. the euthyroid group (n = 2279), who were IHD free at baseline.
Incident IHD was significantly higher in the SCH group [adjusted hazard ratio 1.76 (95% confidence interval 1.15-2.71); P = 0.01]. IHD mortality was also increased in the SCH group [hazard ratio of 1.79 (1.02-3.56); P = 0.05]. These findings lost their significance when subsequent treatment with levothyroxine was excluded from the regression model. There was no difference in all-cause mortality between the groups.
In the Whickham Survey, there is an association between incident IHD events and IHD-related mortality with SCH over the 20 yr of follow-up. Furthermore, subsequent treatment of SCH with levothyroxine appears to attenuate IHD-related morbidity and mortality, and this may explain why some other longitudinal studies of SCH have not shown such an association; properly designed controlled trials of treatment of SCH are required to answer this question definitively.
威克姆调查评估了甲状腺功能和甲状腺自身抗体状态分层的社区居民 20 年内的血管事件。未发现缺血性心脏病 (IHD) 与包括亚临床甲状腺功能减退症 (SCH)、甲状腺抗体阳性或使用左甲状腺素的个体在内的复合自身免疫性甲状腺疾病组之间存在关联。这一结果似乎与其他队列研究的结果不一致。
本研究的目的是评估参与者的甲状腺状况与新发 IHD 和死亡率之间的关系。
结果、设计和参与者：重新分析了数据，评估了 20 年随访期间，基线时无 IHD 的个体中内源性 SCH（n = 97；TSH 6.0-15 mIU/l）与甲状腺功能正常组（n = 2279）之间新发 IHD 事件和死亡率。
SCH 组的新发 IHD 明显更高[调整后的危险比 1.76（95%置信区间 1.15-2.71）；P = 0.01]。SCH 组的 IHD 死亡率也增加[危险比 1.79（1.02-3.56）；P = 0.05]。当将左甲状腺素的后续治疗从回归模型中排除时，这些发现失去了意义。两组之间的全因死亡率没有差异。
在威克姆调查中，SCH 患者在 20 年随访期间新发 IHD 事件和 IHD 相关死亡率之间存在关联。此外，SCH 随后用左甲状腺素治疗似乎可以减轻 IHD 相关发病率和死亡率，这可能解释了为什么其他一些 SCH 的纵向研究没有显示出这种关联；需要进行设计良好的 SCH 治疗对照试验来明确回答这个问题。
