胺碘酮诱发的射血分数降低的心力衰竭患者甲状腺毒症：一项回顾性队列研究。
Amiodarone-induced thyrotoxicosis in heart failure with a reduced ejection fraction: A retrospective cohort study.
作者信息
Yamamoto Jennifer M, Katz Pamela M, Bras James A F, Shafer Leigh Anne, Leung Alexander A, Ravandi Amir, Cordova Francisco J
机构信息
Department of Medicine University of Calgary Calgary Alberta Canada.
Department of Internal Medicine, Rady Faculty of Health Science, Max Rady College of Medicine University of Manitoba Winnipeg Manitoba Canada.
出版信息
Health Sci Rep. 2018 Apr 16;1(5):e36. doi: 10.1002/hsr2.36. eCollection 2018 May.
BACKGROUND
Amiodarone-induced thyrotoxicosis (AIT) is associated with significant morbidity and mortality. We aimed to describe AIT and its clinical outcomes in patients with heart failure with reduced ejection fraction (HFrEF).
METHODS
We performed a retrospective chart review at a heart failure center in Winnipeg, Canada. We screened 1059 consecutive patients seen over a 12-month period (August 2011 to July 2012) for AIT in patients with HFrEF. Using descriptive and Cox proportional hazard analyses, we explored the association between AIT and mortality.
RESULTS
A total of 110 patients with HFrEF who were exposed to amiodarone were included in the analysis. Of these, 13 (11.8%) were diagnosed with AIT. All AIT patients in our cohort were male. Amiodarone was discontinued in nearly half (46.2%) of patients with AIT. All patients were treated with antithyroid medications, and 5 patients (38.5%) also received prednisone. Euthyroidism was achieved in 2 patients (15.4%), hypothyroidism occurred in 6 patients (46.2%), and 5 patients remained thyrotoxic until death or time of chart review (38.5%).
CONCLUSION
Thyrotoxicosis is common in patients with HFrEF on amiodarone and is challenging to treat. Due to the sample size, while no association was found in mortality for patients with HFrEF with AIT, a real association could have been missed.
背景
胺碘酮所致甲状腺毒症（AIT）与显著的发病率和死亡率相关。我们旨在描述射血分数降低的心力衰竭（HFrEF）患者中的AIT及其临床结局。
方法
我们在加拿大温尼伯的一家心力衰竭中心进行了一项回顾性病历审查。我们筛查了在12个月期间（2011年8月至2012年7月）连续就诊的1059例HFrEF患者是否发生AIT。使用描述性分析和Cox比例风险分析，我们探讨了AIT与死亡率之间的关联。
结果
共有110例暴露于胺碘酮的HFrEF患者纳入分析。其中，13例（11.8%）被诊断为AIT。我们队列中的所有AIT患者均为男性。近一半（46.2%）的AIT患者停用了胺碘酮。所有患者均接受抗甲状腺药物治疗，5例患者（38.5%）还接受了泼尼松治疗。2例患者（15.4%）实现了甲状腺功能正常，6例患者（46.2%）发生了甲状腺功能减退，5例患者直至死亡或病历审查时仍处于甲状腺毒症状态（38.5%）。
结论
在接受胺碘酮治疗的HFrEF患者中，甲状腺毒症很常见且治疗具有挑战性。由于样本量的原因，虽然未发现HFrEF合并AIT患者的死亡率存在关联，但可能遗漏了实际存在的关联。
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