甲状腺功能亢进症对冠状动脉疾病的影响：一项计算机断层血管造影研究。
Effects of Hyperthyroidism on Coronary Artery Disease: A Computed Tomography Angiography Study.
机构信息
Innsbruck Medical University, Department of Internal Medicine III - Cardiology and Angiology, Innsbruck, Austria; Innsbruck Medical University, Department of Radiology, Innsbruck, Austria.
Innsbruck Medical University, Department of Internal Medicine III - Cardiology and Angiology, Innsbruck, Austria.
出版信息
Can J Cardiol. 2017 Oct;33(10):1327-1334. doi: 10.1016/j.cjca.2017.07.002. Epub 2017 Jul 17.
BACKGROUND
Changes in thyroid hormone concentration can negatively affect the cardiovascular system. Subclinical hyperthyroidism has been linked to an increase of cardiovascular heart disease, however, clinical effects and significance are still uncertain. Therefore, we analyzed coronary computed tomography angiographies of patients with overt and subclinical hyperthyroidism for quantitative parameters and plaque morphology.
METHODS
Seven hundred forty-four (47.1% female) patients who underwent coronary computed tomography angiography were stratified into 3 groups: 51 patients with overt, 74 patients with subclinical hyperthyroidism, and 619 patients with euthyroidism. Analysis included grades of stenosis (no stenosis = 0, mild < 50%, intermediate 50%-70%, or high-grade > 70%) and plaque types (noncalcified, mixed, and calcified), segment involvement score (SIS), noncalcified SIS, and high-risk plaque features (napkin ring sign, low attenuation plaque, spotty calcifications, positive remodelling).
RESULTS
Patients with overt and subclinical hyperthyroidism had more high-grade stenoses (39.2% vs 37.8% vs 24.2%; P = 0.007) and a higher coronary calcium score (456.5 vs 199.5 vs 155.9; P < 0.0001). Also, a total higher plaque burden has been found (SIS: 3.3 vs 3.2 vs 2.2; P < 0.0001; noncalcified SIS (1.2 vs 1.1 vs 0.6; P < 0.0001)). Patients with overt hyperthyroidism, followed by those with subclinical hyperthyroidism, had the most high-risk plaque features: napkin ring (21.6% vs 9.5% vs 6.0%, P < 0.0001), low attenuation plaque (35.3% vs 27% vs 8.7%, P < 0.0001), spotty calcification (35.3% vs 18.9% vs 19.1%, P = 0.02), and positive remodelling (37.3% vs 37.8% vs 25.5%, P = 0.02). After a mean follow-up of 168 months, significantly more revascularizations were documented for hyperthyroid patients.
CONCLUSIONS
Patients with subclinical and overt hyperthyroidism showed more high-grade coronary stenoses, plaque burden, and high-risk plaque features than patients with euthyroidism, which indicates that an increase of thyroid hormones might lead to coronary vascular degeneration and plaque instability.
背景
甲状腺激素浓度的变化可能会对心血管系统产生负面影响。亚临床甲状腺功能亢进症与心血管疾病的增加有关，但临床影响和意义仍不确定。因此，我们分析了显性和亚临床甲状腺功能亢进症患者的冠状动脉计算机断层扫描血管造影术的定量参数和斑块形态。
方法
744 名（47.1%为女性）接受冠状动脉计算机断层扫描血管造影术的患者分为 3 组：51 名显性甲状腺功能亢进症患者、74 名亚临床甲状腺功能亢进症患者和 619 名甲状腺功能正常患者。分析包括狭窄程度（无狭窄=0、轻度<50%、中度 50%-70%、重度>70%）和斑块类型（非钙化、混合和钙化）、节段受累评分（SIS）、非钙化 SIS 和高危斑块特征（餐巾环征、低衰减斑块、点状钙化、阳性重塑）。
结果
显性和亚临床甲状腺功能亢进症患者的重度狭窄比例更高（39.2%比 37.8%比 24.2%；P=0.007），冠状动脉钙评分也更高（456.5 比 199.5 比 155.9；P<0.0001）。此外，总斑块负荷也更高（SIS：3.3 比 3.2 比 2.2；P<0.0001；非钙化 SIS：1.2 比 1.1 比 0.6；P<0.0001）。显性甲状腺功能亢进症患者，其次是亚临床甲状腺功能亢进症患者，具有最多的高危斑块特征：餐巾环征（21.6%比 9.5%比 6.0%，P<0.0001）、低衰减斑块（35.3%比 27%比 8.7%，P<0.0001）、点状钙化（35.3%比 18.9%比 19.1%，P=0.02）和阳性重塑（37.3%比 37.8%比 25.5%，P=0.02）。在平均 168 个月的随访后，甲状腺功能亢进症患者的血运重建明显更多。
结论
亚临床和显性甲状腺功能亢进症患者的冠状动脉重度狭窄、斑块负荷和高危斑块特征比甲状腺功能正常患者更多，这表明甲状腺激素的增加可能导致冠状动脉血管退化和斑块不稳定。
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