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甲状腺切除术后心血管风险长期升高

Elevated Cardiovascular Risk Persists Long After Thyroidectomy
来源:EGMN 2012-07-25 09:21点击次数:362发表评论

休斯敦——内分泌学会年会上公布的一项芬兰人群队列研究显示,在手术治疗甲状腺功能亢进的患者中,心血管风险增加的情况在术后可持续存在至少20年。


最近有研究者对长期随访接受治疗的甲状腺功能亢进患者的6项研究进行Meta分析后发现,与年龄和性别匹配的对照者相比,甲状腺功能亢进患者的心血管死亡率增加19%(Eur. J. Endocrinol. 2011;165:491-7)。不过,这些患者多数接受的是放射性碘治疗,因此芬兰坦佩雷大学医院的Saara Metso博士及其同事产生了对接受手术治疗的患者进行研究的动机。



Saara Metso博士


该研究纳入1986~2007年期间在芬兰接受甲状腺切除术治疗的4,334例甲状腺功能亢进患者,并从一般人群中选取12,991人作为对照者。


中位随访10.5年的结果显示,甲状腺切除术组和对照组因各种心血管原因所致的住院率分别为240.5/10,000人-年和206.2/10,000人-年,前者的心血管住院风险显著增高17%。


然而,并不是所有类型的心血管疾病的住院风险均增加。例如,甲状腺切除术组的冠状动脉疾病、脑血管疾病或心力衰竭住院率与对照组无显著差异;而高血压住院率高出27%,房颤住院率高出51%,非细菌性心内/心包/心肌疾病、心脏瓣膜疾病和心肌病住院率高出54%。


该研究与前述Meta分析共同表明,导致甲状腺功能亢进患者心血管风险持续增高的可能是甲状腺功能亢进这一疾病而非治疗。


一些与会者希望能够将接受放射性碘治疗的甲状腺功能亢进患者作为对照组,还希望该研究能够提供有关甲状腺切除术后甲状腺替代激素治疗的信息,以确定这是否是导致甲状腺切除术组观察到心血管风险增加的潜在原因。一位与会者表示,难以理解甲状腺切除术不良心血管效应如何能够持续存在20年。


这项芬兰研究获pirkanmaa医院研究基金资助。Metso博士声明称无经济利益冲突。


爱思唯尔  版权所有


By: BRUCE JANCIN, Clinical Endocrinology News Digital Network


HOUSTON – Patients with surgically treated hyperthyroidism have a lingering elevation in cardiovascular risk that persists for at least 2 decades post thyroidectomy, according to a Finnish national study.


“This is the first study to show increased risk of hospitalization for cardiovascular disease after thyroid surgery. The elevated risk is sustained 20 years after surgery. This is in line with previous studies done in patients treated with radioactive iodine. Thus, it’s probably the disease rather than the treatment that affects the patient’s heart permanently,” said Dr. Saara Metso of Tampere (Finland) University Hospital.


At the annual meeting of the Endocrine Society, she presented a population-based cohort study involving 4,334 hyperthyroid patients treated with thyroidectomy at any hospital in Finland during 1986-2007, along with 12,991 controls drawn from the general population.


The hospitalization rate for all cardiovascular causes during a median 10.5 years of follow-up was 240.5 per 10,000 person-years in the thyroidectomy group, compared with 206.2 per 10,000 person-years among controls.


These rates translated into a highly significant 17% increased risk of cardiovascular hospitalization in patients after they have undergone thyroidectomy. The risk, however, was not elevated across the board for all forms of cardiovascular disease. For example, there was no significant difference between patients and controls in hospitalization rates for coronary artery disease, cerebrovascular disease, or heart failure. On the other hand, patients with surgically treated hyperthyroidism had a 27% greater rate of hospitalization for hypertension; a 51% increase in admissions for atrial fibrillation; and a 54% greater hospitalization rate for nonbacterial endo-, peri- and myocardial diseases, valvular diseases, and cardiomyopathy, she continued.


Dr. Metso noted that a recent meta-analysis of six studies featuring long-term follow-up of patients treated for hyperthyroidism showed that the subjects had a 19% increase in cardiovascular mortality relative to age- and sex-matched controls (Eur. J. Endocrinol. 2011;165:491-7). However, most of these patients had been treated with radioiodine. This is what prompted Dr. Metso and her coinvestigators to take a close look at surgically treated patients. The most common causes of their surgically treated hyperthyroidism were Graves disease in 48% of patients, multinodular goiter in 33%, and toxic adenoma in 6%.


Several audience members, while quick to praise the Finnish study as an important advance in the field, expressed a wish that Dr. Metso and her coworkers would have included radioiodine-treated hyperthyroid patients as a control group. Audience members also would have welcomed information on postthyroidectomy thyroid replacement hormone dosing to assess whether that could be a potential contributor to the observed increase in cardiovascular risk in thyroidectomized patients.


“It’s hard to understand how the adverse cardiovascular effects could last 2 decades after the end of hyperthyroidism,” one physician commented.


The Finnish national study was funded by the Pirkanmaa Hospital Research Fund. Dr. Metso reported having no financial conflicts.


学科代码:心血管病学 内分泌学与糖尿病 外科学 耳鼻喉科学   关键词:内分泌学会年会 甲状腺切除术后心血管风险
来源: EGMN
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