老年人亚临床甲状腺功能减退症患者接受左甲状腺素治疗的心血管和骨骼健康结局：系统评价和荟萃分析。

Cardiovascular and bone health outcomes in older people with subclinical hypothyroidism treated with levothyroxine: a systematic review and meta-analysis.

机构信息

School of Medicine, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.

Translational and Clinical Research Institute, Newcastle University, Newcastle-Upon-Tyne, UK.

出版信息

Syst Rev. 2024 May 8;13(1):123. doi: 10.1186/s13643-024-02548-7.

DOI:10.1186/s13643-024-02548-7

PMID:38720372

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11077844/

Abstract

BACKGROUND

Thyroid dysfunction is common in older people, with females at higher risk. Evidence suggests that thyroid-stimulating hormone (TSH) levels naturally increase with age. However, as uniform serum TSH reference ranges are applied across the adult lifespan, subclinical hypothyroidism (SCH) diagnosis is more likely in older people, with some individuals also being commenced treatment with levothyroxine (LT4). It is unclear whether LT4 treatment in older people with SCH is associated with adverse cardiovascular or bone health outcomes.

METHODS

A systematic review and meta-analysis were performed to synthesise previous studies evaluating cardiovascular and bone health outcomes in older people with SCH, comparing LT4 treatment with no treatment. PubMed, Embase, Cochrane Library, MEDLINE, and Web of Science databases were searched from inception until March 13, 2023, and studies that evaluated cardiovascular and bone health events in people with SCH over 50 years old were selected.

RESULTS

Six articles that recruited 3853 participants were found, ranging from 185 to 1642 participants, with the proportion of females ranging from 45 to 80%. The paucity of data resulted in analysis for those aged over 65 years only. Additionally, a study with 12,212 participants aged 18 years and older was identified; however, only data relevant to patients aged 65 years and older were considered for inclusion in the systematic review. Of these 7 studies, 4 assessed cardiovascular outcomes, 1 assessed bone health outcomes, and 2 assessed both. A meta-analysis of cardiovascular outcomes revealed a pooled hazard ratio of 0.89 (95% CI 0.71-1.12), indicating no significant difference in cardiovascular risk between older individuals with SCH treated with LT4 compared to those without treatment. Due to overlapping sub-studies, meta-analysis for bone health outcomes was not possible.

CONCLUSIONS

This systematic review and meta-analysis found no significant association between LT4 use and cardiovascular and bone health outcomes in SCH participants over 65 years.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022308006.

摘要

背景

甲状腺功能障碍在老年人中很常见，女性风险更高。有证据表明，促甲状腺激素（TSH）水平会随着年龄的增长而自然升高。然而，由于在整个成年期都应用统一的血清 TSH 参考范围，因此在老年人中更容易诊断出亚临床甲状腺功能减退症（SCH），一些人也开始接受左甲状腺素（LT4）治疗。目前尚不清楚在患有 SCH 的老年人中使用 LT4 治疗是否与不良心血管或骨骼健康结果相关。

方法

进行了系统评价和荟萃分析，以综合评估比较 LT4 治疗与不治疗的情况下，患有 SCH 的老年人的心血管和骨骼健康结局的先前研究。检索了 PubMed、Embase、Cochrane 图书馆、MEDLINE 和 Web of Science 数据库，检索时间从创建到 2023 年 3 月 13 日，并选择评估年龄在 50 岁以上的 SCH 患者心血管和骨骼健康事件的研究。

结果

共发现 6 篇文章，招募了 3853 名参与者，参与者人数从 185 到 1642 人不等，女性比例从 45%到 80%不等。由于数据有限，仅对年龄在 65 岁以上的人群进行了分析。此外，还确定了一项纳入 18 岁及以上 12212 名参与者的研究，但仅考虑纳入与 65 岁及以上患者相关的数据。在这 7 项研究中，有 4 项评估了心血管结局，1 项评估了骨骼健康结局，2 项同时评估了这两个结局。对心血管结局的荟萃分析显示，风险比为 0.89（95%CI 0.71-1.12），表明在接受 LT4 治疗的 SCH 老年患者与未接受治疗的患者之间，心血管风险无显著差异。由于重叠的亚研究，无法对骨骼健康结局进行荟萃分析。