Zhang Shaojun, Feng Guilong, Kang Fangfang, Guo Yali, Ti Hongyan, Hao Lufang, Gao Peng, Gao Jiangqin
Department of Endocrinology, Shanxi Province People's Hospital, Taiyuan, China.
Department of Endocrinology, The Sixth Division Hospital of Xinjiang Production and Construction Corps, Wujiaqu, China.
Front Endocrinol (Lausanne). 2020 Jan 10;10:889. doi: 10.3389/fendo.2019.00889. eCollection 2019.
This study investigated the relationship strength between hypothyroidism and cardiovascular and renal outcomes in diabetic patients. The electronic databases PubMed, EmBase, and Cochrane library were screened for relevant studies published before November 2018. The outcomes included major cardiovascular events (MACEs), all-cause mortality, cardiac death, stroke, diabetic nephropathy (DN), diabetic retinopathy (DR), and chronic kidney disease (CKD). The pooled results for all outcomes were calculated using random-effects models. A total of eight studies met the inclusion criteria. The summary results indicated that hypothyroidism was not associated with the risk of MACEs (OR:1.21; 95%CI:0.68-2.16; = 0.514), all-cause mortality (OR:1.27; 95%CI:0.93-1.74; = 0.136), cardiac death (OR:1.16; 95%CI:0.89-1.52; = 0.271), stroke (OR:0.96; 95%CI: 0.49-1.88; = 0.915), and DN (OR:1.71; 95%CI:0.37-7.90; = 0.490). There was a significant association between hypothyroidism and the risk of DR (OR:1.73; 95%CI:1.08-2.77; = 0.023) and CKD (OR:1.22; 95%CI:1.10-1.36; < 0.001). These findings indicate that diabetic patients with hypothyroidism have an increased risk of DR and CKD. Additional large-scale prospective studies should be carried out to verify the prognosis of patients with diabetes and hypothyroidism.
本研究调查了糖尿病患者甲状腺功能减退与心血管及肾脏结局之间的关联强度。检索了电子数据库PubMed、EmBase和Cochrane图书馆，以查找2018年11月之前发表的相关研究。结局包括主要心血管事件（MACE）、全因死亡率、心源性死亡、中风、糖尿病肾病（DN）、糖尿病视网膜病变（DR）和慢性肾脏病（CKD）。使用随机效应模型计算所有结局的合并结果。共有八项研究符合纳入标准。汇总结果表明，甲状腺功能减退与MACE风险（OR：1.21；95%CI：0.68 - 2.16；P = 0.514）、全因死亡率（OR：1.27；95%CI：0.93 - 1.74；P = 0.136）、心源性死亡（OR：1.16；95%CI：0.89 - 1.52；P = 0.271）、中风（OR：0.96；95%CI：0.49 - 1.88；P = 0.915）及DN（OR：1.71；95%CI：0.37 - 7.90；P = 0.490）均无关联。甲状腺功能减退与DR风险（OR：1.73；95%CI：1.08 - 2.77；P = 0.023）及CKD风险（OR：1.22；95%CI：1.10 - 1.36；P < 0.001）之间存在显著关联。这些发现表明，甲状腺功能减退的糖尿病患者发生DR和CKD的风险增加。应开展更多大规模前瞻性研究以验证糖尿病合并甲状腺功能减退患者的预后情况。
