School of Medicine, Jiangsu University, Zhenjiang, Jiangsu, China.
Department of Endocrinology, Gansu Provincial Hospital, Lanzhou, Gansu, China.
Am J Cardiovasc Drugs. 2022 Nov;22(6):647-656. doi: 10.1007/s40256-022-00548-3. Epub 2022 Sep 1.
Previous research demonstrated that short-term treatment of dilated cardiomyopathy with thyroid hormones exerted beneficial hemodynamic effects when added to standard anti-heart failure therapy, but it remains debatable whether thyroid hormones can be used to treat dilated cardiomyopathy. Therefore, we conducted a meta-analysis to evaluate the effectiveness and safety of thyroid hormone treatment in patients with dilated cardiomyopathy.
The Cochrane Clinical Trials Registry database, PubMed, Embase, Chinese Biomedical Literature Database, China Academic Journals full-text database, Wanfang Database, China Science and Technology Journal Database, and Clinical Trials.gov were screened through 15 October, 2021. Randomized controlled clinical trials were selected based on study inclusion criteria. Two independent reviewers extracted the data and assessed study bias using the Cochrane risk of bias tool. For the data synthesis, the weighted mean difference was calculated using baseline and post-thyroid hormone treatment data. Random-effects models were used for the meta-analysis. The primary outcomes were left ventricular ejection fraction after a minimum follow-up of 1 week and adverse events.
Ten of the 1149 published reports met the inclusion criteria (N = 608 randomized individuals). After reasonable use of thyroid hormone therapy, left ventricular ejection fraction increased (weighted mean difference, 3.94; 95% confidence interval 3.06-4.81; I = 0.00%), cardiac output increased, and left ventricular end-diastolic diameter decreased, but left ventricular mass index and thyroid function were unaffected. Adverse events were reported in the intervention group of two studies. The ten studies demonstrated a low risk of bias.
Adding thyroid hormones to conventional anti-heart failure treatment in patients with DCM appears to be an effective and well tolerated therapeutic option.
The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42021286043).
先前的研究表明，在标准抗心力衰竭治疗的基础上，短期应用甲状腺激素治疗扩张型心肌病可产生有益的血液动力学效应，但甲状腺激素是否可用于治疗扩张型心肌病仍存在争议。因此，我们进行了一项荟萃分析，以评估甲状腺激素治疗扩张型心肌病患者的有效性和安全性。
通过 Cochrane 临床对照试验注册库、PubMed、Embase、中国生物医学文献数据库、中国学术期刊全文数据库、万方数据库、中国科技期刊数据库和 ClinicalTrials.gov 对截至 2021 年 10 月 15 日的文献进行筛选，根据纳入标准选择随机对照临床试验。两名独立评审员使用 Cochrane 偏倚风险工具提取数据并评估研究偏倚。对于数据综合，使用基线和甲状腺激素治疗后的数据计算加权均数差。使用随机效应模型进行荟萃分析。主要结局是随访至少 1 周后的左心室射血分数和不良事件。
在已发表的 1149 篇报告中，有 10 篇（N=608 名随机个体）符合纳入标准。合理应用甲状腺激素治疗后，左心室射血分数增加（加权均数差，3.94；95%置信区间 3.06-4.81；I=0.00），心输出量增加，左心室舒张末期内径减小，但左心室质量指数和甲状腺功能不受影响。两项研究的干预组报告了不良事件。这 10 项研究显示出低偏倚风险。
在 DCM 患者中，在常规抗心力衰竭治疗的基础上联合应用甲状腺激素似乎是一种有效且耐受良好的治疗选择。
该方案已在国际前瞻性系统评价注册库（PROSPERO）数据库（CRD42021286043）注册。
