Division of Cardiology, Department of Internal Medicine, Busan Veterans Hospital, Busan, Korea.
Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
Korean Circ J. 2015 Mar;45(2):125-30. doi: 10.4070/kcj.2015.45.2.125. Epub 2015 Mar 24.
Subclinical hypothyroidism is associated with endothelial dysfunction and impaired coronary flow reserve. However, the effect of subclinical hypothyroidism or thyroid autoimmunity on variant angina has yet to be determined.
Among 385 consecutive patients without associated cardiovascular risk factors who underwent coronary angiography with the ergonovine provocation test (EPT), 165 had a positive EPT {EPT(+)} and 220 had a negative EPT {EPT(-)}. The relationship between coronary artery spasm and the presence of subclinical thyroid dysfunction as well as serum thyroid peroxidase autoantibody (TPO Ab) was evaluated.
The proportion of patients with subclinical hypothyroidism among those who were EPT(+) was significantly higher than that in those who were EPT(-) (18% vs. 11%, p=0.001). However, there was no significant difference in the proportion of patients with subclinical hyperthyroidism between the groups. Moreover, EPT(+) patients showed significantly more positive TPO Ab (33% vs. 14%, p<0.001) than those with EPT(-). There was a positive correlation between EPT(+) and TPO positivity (r=0.226, p<0.001), subclinical hypothyroidism (r=0.112, p=0.033), and body mass index (r=0.123, p=0.018). Binary logistic regression analysis revealed that the significant predictors of EPT(+) were body mass index {adjusted odds ratio (OR)=1.042, 95% confidence interval (CI)=1.005-1.080}, presence of subclinical hypothyroidism (OR=3.047, 95% CI=1.083-8.572), TPO Ab titer (OR=1.028, 95% CI=1.015-1.041), and the presence of TPO Ab (OR=4.904, 95% CI=1.544-15.567).
Subclinical hypothyroidism and the presence of TPO Ab are significantly associated with coronary vasospasm in patients without cardiovascular risk factors.
亚临床甲状腺功能减退与血管内皮功能障碍和冠状动脉血流储备受损有关。然而，亚临床甲状腺功能减退或甲状腺自身免疫对变异型心绞痛的影响尚未确定。
在 385 例连续行冠状动脉造影和麦角新碱激发试验（EPT）的患者中，165 例 EPT 阳性（EPT(+)），220 例 EPT 阴性（EPT(-)）。评估了冠状动脉痉挛与亚临床甲状腺功能障碍以及血清甲状腺过氧化物酶自身抗体（TPO Ab）之间的关系。
EPT(+)患者中亚临床甲状腺功能减退的比例明显高于 EPT(-)患者（18%比 11%，p=0.001）。然而，两组间亚临床甲状腺功能亢进患者的比例无显著差异。此外，EPT(+)患者的 TPO Ab 阳性率明显高于 EPT(-)患者（33%比 14%，p<0.001）。EPT(+)与 TPO 阳性（r=0.226，p<0.001）、亚临床甲状腺功能减退（r=0.112，p=0.033）和体重指数（r=0.123，p=0.018）呈正相关。二元逻辑回归分析显示，EPT(+)的显著预测因素为体重指数（调整后的优势比[OR]=1.042，95%置信区间[CI]=1.005-1.080）、亚临床甲状腺功能减退（OR=3.047，95%CI=1.083-8.572）、TPO Ab 滴度（OR=1.028，95%CI=1.015-1.041）和 TPO Ab 阳性（OR=4.904，95%CI=1.544-15.567）。
无心血管危险因素的患者中，亚临床甲状腺功能减退和 TPO Ab 阳性与冠状动脉血管痉挛显著相关。
