Chen Qingxing, Yan Yan, Zhang Lei, Cheng Kuan, Liu Yuping, Zhu Wenqing
Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
Cardiology. 2014;127(3):176-82. doi: 10.1159/000356954. Epub 2014 Jan 14.
To clarify whether hyperthyroidism (HT) itself confers an additional effect on the hypercoagulable state and the risk of ischemic stroke among patients with hyperthyroid atrial fibrillation (AF).
We prospectively evaluated plasma D-dimer levels and thromboembolic events among three groups of patients (hyperthyroid AF, n = 62; nonthyroid AF, n = 107, and HT without AF, n = 100). Plasma D-dimer levels were used to evaluate the hypercoagulable state.
The D-dimer level was significantly higher in patients with hyperthyroid AF than in nonthyroid AF (0.66 ± 0.06 vs. 0.34 ± 0.02 mg/l, p < 0.001) and HT without AF (0.66 ± 0.06 vs. 0.27 ± 0.02 mg/l, p < 0.001). During a 3-year follow-up, patients with hyperthyroid AF had a significantly higher incidence of ischemic stroke compared with patients with nonthyroid AF (hazard ratio, HR: 3.2, 95% confidence interval, CI: 1.01-5.59, p = 0.04). Cox regression analysis revealed that age (HR: 2.5, 95% CI: 1.01-1.21, p = 0.05), CHADS2-VAS score (HR: 5.5, 95% CI: 1.51-7.43, p = 0.01) and anticoagulation (HR: 0.45, 95% CI: 0.07-0.54, p = 0.01) were independent predictors of risk for the occurrence of ischemic stroke.
The present study suggests that HT may enhance the hypercoagulable state and the risk of ischemic stroke in patients with AF.
明确甲状腺功能亢进症（HT）本身是否会对甲状腺功能亢进性心房颤动（AF）患者的高凝状态及缺血性卒中风险产生额外影响。
我们前瞻性评估了三组患者（甲状腺功能亢进性AF，n = 62；非甲状腺AF，n = 107，以及无AF的HT，n = 100）的血浆D-二聚体水平和血栓栓塞事件。血浆D-二聚体水平用于评估高凝状态。
甲状腺功能亢进性AF患者的D-二聚体水平显著高于非甲状腺AF患者（0.66±0.06 vs. 0.34±0.02 mg/l，p < 0.001）以及无AF的HT患者（0.66±0.06 vs. 0.27±0.02 mg/l，p < 0.001）。在3年的随访期间，甲状腺功能亢进性AF患者的缺血性卒中发生率显著高于非甲状腺AF患者（风险比，HR：3.2，95%置信区间，CI：1.01 - 5.59，p = 0.04）。Cox回归分析显示，年龄（HR：2.5，95% CI：1.01 - 1.21，p = 0.05）、CHADS2-VAS评分（HR：5.5，95% CI：1.51 - 7.43，p = 0.01）和抗凝治疗（HR：0.45，95% CI：0.07 - 0.54，p = 0.01）是缺血性卒中发生风险的独立预测因素。
本研究提示，HT可能会增强AF患者的高凝状态及缺血性卒中风险。
