手术与药物治疗对格雷夫斯病心血管表现的影响。

Impact of surgery versus medical management on cardiovascular manifestations in Graves disease.

机构信息

Department of Surgery, Tulane University School of Medicine, New Orleans, LA.

出版信息

Surgery. 2021 Jan;169(1):82-86. doi: 10.1016/j.surg.2020.03.023. Epub 2020 May 10.

DOI:10.1016/j.surg.2020.03.023

PMID:32402541

Abstract

BACKGROUND

Graves disease is well known to have multiple adverse effects on the cardiovascular system. We compared the cardiovascular outcomes after surgical intervention versus medical treatment in patients with Graves disease.

METHODS

We performed a retrospective study of all Graves disease patients with a cardiovascular comorbidity who underwent either surgical or medical management (N = 151). Perioperative biochemical and cardiovascular outcomes from the surgical versus the medical groups were analyzed.

RESULTS

Of 151 patients, 69 (45.6%) patients underwent total thyroidectomy and 82 (54.3%) patients received medical treatment. Hypertension resolved in 44.7% of the patients from the surgical group vs 18% in the medical group (P = .03). Tachyarrhythmias, including atrial fibrillation and tachycardia, improved in 85.9% of patients in the surgical group vs 66% in the medical group (P = .01). All cardiovascular manifestations examined, hypertension, tachyarrhythmias, and heart failure, improved in 69% of patients in the surgical group and 42.6% of patients in the medical group during the follow-up period (P < .01).

CONCLUSION

Surgical treatment offers a significant and rapid clinical improvement of cardiovascular manifestations in Graves disease patients, such as hypertension, tachyarrhythmias, and heart failure. Surgery should be considered and recommended in Graves disease patients with known cardiovascular manifestations.

摘要

背景

众所周知，格雷夫斯病（Graves disease）对心血管系统有多种不良影响。我们比较了格雷夫斯病患者手术干预与药物治疗后的心血管结局。

方法

我们对所有患有心血管合并症并接受手术或药物治疗的格雷夫斯病患者进行了回顾性研究（N=151）。分析了手术组与药物组患者的围手术期生化和心血管结局。

结果

在 151 例患者中，69 例（45.6%）患者行甲状腺全切除术，82 例（54.3%）患者接受药物治疗。手术组中 44.7%的高血压患者得到缓解，而药物组中仅 18%的患者得到缓解（P=0.03）。手术组中 85.9%的心动过速患者（包括心房颤动和心动过速）得到改善，而药物组中仅 66%的患者得到改善（P=0.01）。在随访期间，手术组中 69%的患者和药物组中 42.6%的患者的所有心血管表现（高血压、心动过速和心力衰竭）均得到改善（P<0.01）。