亚临床甲状腺功能减退症是否影响慢性收缩性心力衰竭患者的预后：系统评价和荟萃分析。
Does subclinical hypothyroidism affect the prognosis of patients with chronic systolic heart failure: A systematic review and meta-analysis.
机构信息
Department of Endocrinology and Metabolism, Changchun University of Traditional Chinese Medicine, Changchun, Jilin Province, China.
Department of Endocrinology and Metabolism, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin Province, China.
出版信息
Medicine (Baltimore). 2024 Jun 7;103(23):e38410. doi: 10.1097/MD.0000000000038410.
BACKGROUND
Chronic systolic heart failure (CSHF) is a significant health burden with high morbidity and mortality. The role of subclinical hypothyroidism (SCH) in the prognosis of CSHF patients remains a critical area of inquiry. This systematic review and meta-analysis aim to elucidate the impact of SCH on the prognosis of patients with CSHF.
METHODS
Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, this meta-analysis employed a comprehensive search strategy across major databases including PubMed, Embase, Web of Science, and the Cochrane Library. The Patient, Intervention, Comparison, Outcome framework guided the inclusion of studies focusing on patients with CSHF, comparing those with and without SCH. Quality assessment was performed using the Newcastle-Ottawa scale. Statistical analyses assessed heterogeneity and publication bias, employing fixed-effect or random-effects models based on heterogeneity levels.
RESULTS
From an initial pool of 1439 articles, 8 studies met the stringent inclusion criteria. These studies, conducted across diverse geographical regions, highlighted the relationship between SCH and all-cause mortality, cardiac events, and subgroup differences in CSHF patients. The meta-analysis revealed SCH as a significant risk factor for all-cause mortality (HR = 1.42) and cardiac events (HR = 1.46). Subgroup analysis indicated variability in risk based on region, sample size, age, and follow-up duration. Sensitivity analysis confirmed the stability of these findings, and publication bias assessment indicated symmetric funnel plot and nonsignificant Egger test results.
CONCLUSIONS
SCH emerges as a predictive factor for all-cause mortality, cardiovascular events, and rehospitalization in CSHF patients. This finding underscores the importance of screening for SCH in CSHF patients, highlighting its potential role in improving patient prognosis.
背景
慢性收缩性心力衰竭（CSHF）是一种发病率和死亡率都很高的重大健康负担。亚临床甲状腺功能减退症（SCH）在 CSHF 患者预后中的作用仍然是一个关键的研究领域。本系统评价和荟萃分析旨在阐明 SCH 对 CSHF 患者预后的影响。
方法
本荟萃分析遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南，采用全面的搜索策略，涵盖了包括 PubMed、Embase、Web of Science 和 Cochrane 图书馆在内的主要数据库。纳入的研究以 CSHF 患者为对象，比较了伴有和不伴有 SCH 的患者，采用了患者、干预、比较、结局（PICO）框架。质量评估采用了纽卡斯尔-渥太华量表（Newcastle-Ottawa scale）。统计分析评估了异质性和发表偏倚，根据异质性水平采用固定效应或随机效应模型。
结果
从最初的 1439 篇文章中，有 8 项研究符合严格的纳入标准。这些研究在不同的地理区域进行，强调了 SCH 与 CSHF 患者的全因死亡率、心脏事件以及亚组差异之间的关系。荟萃分析显示，SCH 是全因死亡率（HR=1.42）和心脏事件（HR=1.46）的一个显著危险因素。亚组分析表明，风险因地区、样本量、年龄和随访时间而有所不同。敏感性分析证实了这些发现的稳定性，发表偏倚评估表明漏斗图对称且 Egger 检验结果无统计学意义。
结论
SCH 是 CSHF 患者全因死亡率、心血管事件和再住院的预测因素。这一发现强调了在 CSHF 患者中筛查 SCH 的重要性，突出了其在改善患者预后方面的潜在作用。
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