亚临床甲状腺功能减退症患者左心室舒张功能障碍的超声心动图评估：一项病例对照研究。

Echocardiographic evaluation of left ventricular diastolic dysfunction in subclinical hypothyroidism: A case-control study.

作者信息

Malhotra Yuthika, Kaushik Rajeev Mohan, Kaushik Reshma

机构信息

a Department of Medicine , Himalayan Institute of Medical Sciences, Swami Rama Himalayan University , Dehradun , Uttarakhand , India.

出版信息

Endocr Res. 2017 Aug;42(3):198-208. doi: 10.1080/07435800.2017.1292524. Epub 2017 Mar 13.

DOI:10.1080/07435800.2017.1292524

PMID:28287839

Abstract

PURPOSE

To study the prevalence of left ventricular diastolic dysfunction (LVDD) in patients with subclinical hypothyroidism (SCH) and the response of LVDD to L-thyroxine therapy.

MATERIALS AND METHODS

This cross-sectional case-control study with one longitudinal arm included 67 patients with SCH attending a tertiary care hospital in Uttarakhand, India, and 67 age- and sex-matched healthy controls. LVDD was assessed by 2D, pulsed-wave Doppler (PWD), continuous wave Doppler (CWD), and tissue Doppler echocardiography (TDE). Patients with LVDD received L-thyroxine therapy with reassessment for LVDD 6 months later.

RESULTS

SCH patients had a higher prevalence of LVDD than controls (13.43% versus 1.49%; p = 0.017). LVDD showed a significant association with gender (p = 0.004) and serum FT4 (p = 0.001). E velocity, E' velocity, A' velocity, iso-volumetric relaxation time (IVRT), E/A, and E'/A' ratios were significantly lower, while A velocity, deceleration time (DT), E/E' ratio, left atrial (LA) volume index, and peak tricuspid regurgitation (TR) velocity were significantly higher in cases than controls (p < 0.05 each). The E/A ratio correlated significantly with age, serum very low-density lipoprotein (VLDL), triglycerides (TG), thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and high-density lipoprotein (HDL) (p < 0.05 each). E' velocity correlated significantly with age, serum total cholesterol, VLDL, and TG (p < 0.05 each), DT with serum total cholesterol (p = 0.047), and LA volume index with age (p = 0.021). Age (p = 0.016) and serum HDL (p = 0.029) were independent predictors of E/A ratio. Gender was an independent predictor for LVDD (p = 0.003). Echocardiographic indices for LVDD showed significant improvement after 6 months of L-thyroxine therapy (p < 0.05 each).

CONCLUSIONS

LVDD occurs commonly in SCH patients. It can be detected timely using echocardiography and may be reversed by L-thyroxine therapy.

摘要

目的

研究亚临床甲状腺功能减退症（SCH）患者左心室舒张功能障碍（LVDD）的患病率以及LVDD对左旋甲状腺素治疗的反应。

材料与方法

本横断面病例对照研究包括一个纵向研究组，纳入了印度北阿坎德邦一家三级护理医院的67例SCH患者以及67例年龄和性别匹配的健康对照者。通过二维、脉冲波多普勒（PWD）、连续波多普勒（CWD）和组织多普勒超声心动图（TDE）评估LVDD。LVDD患者接受左旋甲状腺素治疗，并在6个月后重新评估LVDD。

结果

SCH患者LVDD的患病率高于对照组（13.43%对1.49%；p = 0.017）。LVDD与性别（p = 0.004）和血清游离甲状腺素（FT4）（p = 0.001）显著相关。病例组的E峰速度、E'峰速度、A'峰速度、等容舒张时间（IVRT）、E/A比值和E'/A'比值显著低于对照组，而A峰速度、减速时间（DT）、E/E'比值、左心房（LA）容积指数和三尖瓣反流（TR）峰值速度显著高于对照组（各p < 0.05）。E/A比值与年龄、血清极低密度脂蛋白（VLDL）、甘油三酯（TG）、促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）和高密度脂蛋白（HDL）显著相关（各p < 0.05）。E'峰速度与年龄、血清总胆固醇、VLDL和TG显著相关（各p < 0.05），DT与血清总胆固醇相关（p = 0.047），LA容积指数与年龄相关（p = 0.021）。年龄（p = 0.016）和血清HDL（p = 0.029）是E/A比值的独立预测因素。性别是LVDD的独立预测因素（p = 0.003）。左旋甲状腺素治疗6个月后，LVDD的超声心动图指标有显著改善（各p < 0.05）。