Qian Yuling, Quan Ruilin, Chen Xiaoxi, Zhang Gangcheng, Yang Yuanhua, Chen Yucheng, Yu Zaixin, Gu Qing, Xiong Changming, Han Huijun, He Jianguo
Department of Pulmonary Vascular Disease, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China.
Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan, China.
ERJ Open Res. 2023 Nov 20;9(6). doi: 10.1183/23120541.00495-2023. eCollection 2023 Nov.
Our objective was to clarify the characteristics and long-term survival of idiopathic pulmonary arterial hypertension (IPAH) patients with thyroid dysfunction and compare them with IPAH without thyroid dysfunction.
A retrospective analysis was conducted using prospectively collected data. IPAH patients with thyroid dysfunction at baseline were included. Patients with other subgroups of PAH and Group 2-5 pulmonary hypertension were excluded. IPAH patients with euthyroid function were matched 1:1 to IPAH patients with thyroid dysfunction by age and sex.
In total, 148 IPAH patients with thyroid dysfunction were included. Patients with hyperthyroidism, hypothyroidism, subclinical hyperthyroidism and subclinical hypothyroidism accounted for 16.2%, 18.9%, 8.1% and 56.8%, respectively. IPAH patients with hyperthyroidism showed the highest mixed venous oxygen saturation () and the lowest pulmonary vascular resistance (PVR) at baseline among subgroups, while patients with subclinical hypothyroidism had the lowest and highest PVR (p<0.05). Compared with IPAH without thyroid dysfunction, patients with hyperthyroidism (9.14 13.86 WU; p<0.05) and hypothyroidism (10.70 13.86 WU; p<0.05) showed significantly lower PVR. The haemodynamic profiles of patients with subclinical hypothyroidism were similar to IPAH with euthyroid function except for lower right atrial pressure (6 8 mmHg; p=0.009). The long-term survival of patients with clinical thyroid dysfunction was better than IPAH without thyroid dysfunction, while that of those with subclinical diseases was comparable to the latter, even after adjusting for baseline haemodynamics and treatment.
IPAH patients with clinical hyper- and hypothyroidism had better haemodynamics and survival than those without thyroid dysfunction, while patients with subclinical hypothyroidism had similar haemodynamics and survival profiles to the latter.
我们的目的是阐明合并甲状腺功能障碍的特发性肺动脉高压（IPAH）患者的特征及长期生存情况，并将其与无甲状腺功能障碍的IPAH患者进行比较。
使用前瞻性收集的数据进行回顾性分析。纳入基线时合并甲状腺功能障碍的IPAH患者。排除其他PAH亚组和2-5组肺动脉高压患者。将甲状腺功能正常的IPAH患者按年龄和性别与合并甲状腺功能障碍的IPAH患者1:1匹配。
共纳入148例合并甲状腺功能障碍的IPAH患者。甲状腺功能亢进、甲状腺功能减退、亚临床甲状腺功能亢进和亚临床甲状腺功能减退患者分别占16.2%、18.9%、8.1%和56.8%。在各亚组中，合并甲状腺功能亢进的IPAH患者在基线时混合静脉血氧饱和度最高，肺血管阻力（PVR）最低，而亚临床甲状腺功能减退患者的混合静脉血氧饱和度最低，PVR最高（p<0.05）。与无甲状腺功能障碍的IPAH患者相比，甲状腺功能亢进（9.14±13.86 WU；p<0.05）和甲状腺功能减退（10.70±13.86 WU；p<0.05）患者的PVR显著更低。除右心房压力更低（6±8 mmHg；p=0.009）外，亚临床甲状腺功能减退患者的血流动力学特征与甲状腺功能正常的IPAH患者相似。即使在对基线血流动力学和治疗进行调整后，临床甲状腺功能障碍患者的长期生存率仍高于无甲状腺功能障碍的IPAH患者，而亚临床甲状腺功能障碍患者的长期生存率与后者相当。
合并临床甲状腺功能亢进和减退的IPAH患者的血流动力学和生存率优于无甲状腺功能障碍的患者，而亚临床甲状腺功能减退患者的血流动力学和生存情况与后者相似。
