亚临床甲状腺功能异常与心血管疾病的关系

临床研究显示,亚临床甲状腺功能异常与心血管疾病之间存在密切的关系.亚临床甲状腺功能减退通常伴有血脂异常、高凝状态、纤维蛋白溶解活性减低等心血管疾病危险因素,其与动脉粥样硬化、冠心病和心血管死亡的风险显著相关.另一方面,亚临床甲状腺功能亢进与心房颤动发生风险显著相关,但与心血管死亡风险的相关性尚不清楚.对于亚临床甲状腺功能异常进行治疗是否能够带来心血管获益,目前尚无确切结论.     

亚临床甲状腺功能异常与心血管疾病的关系

临床研究显示,亚临床甲状腺功能异常与心血管疾病之间存在密切的关系.亚临床甲状腺功能减退通常伴有血脂异常、高凝状态、纤维蛋白溶解活性减低等心血管疾病危险因素,其与动脉粥样硬化、冠心病和心血管死亡的风险显著相关.另一方面,亚临床甲状腺功能亢进与心房颤动发生风险显著相关,但与心血管死亡风险的相关性尚不清楚.对于亚临床甲状腺功能异常进行治疗是否能够带来心血管获益,目前尚无确切结论.     

增龄性亚临床甲状腺功能异常在抗衰老医学中的重要性

<正>神经和内分泌系统是人体两大中枢调控系统,二者相互协调,以维持人体内环境的平衡。甲状腺素分泌和释放受下丘脑-垂体-甲状腺轴调控,互为反馈,如亚临床甲状腺功能减退(及亢进)与促甲状腺释放激素(TSH)血清水平的升高(或降低)的关系。增龄性临床前甲状腺功能异常(又称亚临床甲状腺功能病STD)包括亚临床甲状腺功能减退(SHypo)、亚临床甲状腺功能亢进(SHyper)与一些疾病的相关关系必须给予重视。     

成人非老年亚临床甲状腺功能异常的管理

亚临床甲状腺功能异常在人群中普遍常见,其诊断依赖于实验室检查结果,分为亚临床甲状腺功能减退症和亚临床甲状腺功能亢进症.文章仅涉及成人非老年内源性亚临床甲状腺功能异常,结合近年国内外多个临床指南,重点介绍亚临床甲状腺功能减退和亚临床甲亢非妊娠和妊娠人群相关的管理内容.文章管理建议仅针对非老年(70岁以下的亚临床甲减和65...     

亚临床甲状腺疾病

亚临床甲状腺疾病是指无或有轻微甲状腺疾病相关症状、仅在实验室检查中或通过影像学手段发现的甲状腺异常 ,包括甲状腺意外结节、亚临床甲状腺功能亢进、轻微甲状腺功能减退等。它们可影响正常的生理及代谢过程 ,部分患者可出现相关临床症状。亚临床甲状腺疾病应视患者的具体情况进行个体化处置     

亚临床甲状腺疾病

亚临床甲状腺疾病是指无或有轻微甲状腺疾病相关症状、仅在实验室检查中或通过影像学手段发现的甲状腺异常，包括甲状腺意外结节、亚临床甲状腺功能亢进、轻微甲状腺功能减退先进。它们可影响正常的生理及代谢过程，部分患者可出现相关临床症状。亚临床甲状腺疾病应视患者的具体情况进行个体化处置。     

亚临床甲状腺功能减退与冠心病

亚临床甲状腺功能减退简称(亚临床甲减)是指血液中的甲状腺素水平升高,而游离的甲状腺素、游离的三碘甲状腺原氨酸在正常范围内,是机体的一种代偿使甲状腺激素维持在正常水平。     

亚临床甲状腺功能减退与心血管疾病的研究进展

亚临床甲状腺功能减退症(亚临床甲减)是一种常见、多发病,主要诊断依据是血清TSH水平增高,而游离甲状腺素(FT4)正常。其与心血管疾病的关系已成为当今研究的热点,目前认为亚临床甲减与高胆固醇血症、高血压、吸烟和糖尿病一样,构成动脉粥样硬化和心肌梗死的独立危险因素。本文综述了亚临床甲减与常见心血管疾病的关系及亚临床甲减的干预治疗等方面的进展。     

亚临床甲状腺功能异常与骨质疏松

亚临床甲状腺功能异常(STD)和骨质疏松是常见的内分泌疾病,主要发生在女性和老年人群中.甲状腺激素和促甲状腺激素可直接或间接影响骨代谢,导致骨密度发生变化.而STD患者体内这两种激素水平异常,提示STD和骨质疏松之间存在一定的联系.此外,外源性甲状腺激素替代治疗亦可影响骨代谢,导致骨密度下降和骨质疏松.因此,明确STD和骨质疏松之间的联系并采取适当干预措施对于预防STD患者发生骨质疏松有重要意义.     

亚临床甲状腺功能减退与冠状动脉粥样硬化关系初探

目的探讨亚临床甲状腺功能减退的临床特点及其与冠状动脉硬化的相关性、是否干预等问题。方法对141例亚临床甲状腺功能减退病人的临床资料进行回顾性分析。结果促甲状腺素(TSH)>10mU/L的亚临床甲状腺功能减退组与血脂增高相关,但未证实对心脑血管病发病率增加有影响;TSH<10mU/L的亚临床甲状腺功能减退组与血脂关系不大。结论TSH明显增高的亚临床甲状腺功能减退可考虑早期用L-T4干预,对TSH增高较低的亚临床甲状腺功能减退者仅随访监测。     

Prognostic impact of subclinical thyroid dysfunction in heart failure

Background

Therapeutic and prognostic implications of subclinical thyroid dysfunction in patients with heart failure (HF) are unclear. We compared the prognostic impact of euthyroidism, subclinical thyroid dysfunction, and euthyroid sick syndrome (ESS) in systolic HF.

Methods

We included 1032 patients hospitalized for systolic HF (left ventricular ejection fraction [LVEF] ≤ 40%) who participated in a randomized trial assessing the effects of a HF disease management program. Patients with incomplete thyroid function tests or thyrotropic medication were excluded. In the remaining 758 subjects, the risk of all-cause death was estimated based on TSH only, or full thyroid function profile. Changes of thyroid function after six months were assessed in 451 subjects.

Results

Subclinical thyroid dysfunction was present in 103 patients at baseline (14%). No differences were found between groups regarding NYHA class (P = 0.29), and LVEF (P = 0.60). After a median follow-up of three years patients with ESS (n = 13) had a 3-fold age-adjusted increased risk of death compared to euthyroid patients (P = 0.001). However, neither subclinical hyperthyroidism (HR 1.18, 95%CI:0.82–1.70) nor hypothyroidism (HR 1.07, 95%CI:0.58–1.98) were associated with increased age-adjusted mortality risk. Subclinical thyroid dysfunction had normalized spontaneously at follow-up in 77% of patients. However, persistent subclinical thyroid dysfunction was also not associated with worse outcome.

Conclusions

In this large well-characterized HF cohort, subclinical thyroid dysfunction did not predict an increased mortality risk. Thus, in patients with moderate to severe HF, further diagnostic and therapeutic procedures for subclinical thyroid dysfunction appear dispensable. ESS was an infrequent but important indicator of a poor prognosis in HF.

Clinical trial registration

URL: http://www.controlled-trials.com. Unique identifier: ISRCTN23325295.     

亚临床甲状腺功能减退症患者及甲状腺功能正常者甲状腺功能与血糖水平的关系

目的研究亚临床甲状腺功能减退症患者及甲状腺功能正常者甲状腺功能与血糖的关系。方法采用整群抽样法于2007年至2010年从沈阳市城市成年居民中招募2751名研究对象,行问卷调查,测量血压、身高、体重、腰围、促甲状腺激素、游离三碘甲状腺原氨酸、游离甲状腺素、空腹血糖、口服葡萄糖耐量试验2h血糖、甘油三酯、总胆固醇和高密度脂蛋白胆固醇。将受试者分为亚临床甲状腺功能减退症组（n=193）及甲状腺功能正常组（n=2146）,甲状腺功能正常组又进一步分为促甲状腺激素低水平组（n=352,促甲状腺激素／〉0．3-〈1．0mU／L）、促甲状腺激素中水平组（n=916,促甲状腺激素≥1．0-≤1．9mU／L）、促甲状腺激素高水平组（n=944,促甲状腺激素1．9〈-≤4．8mU／L）。受试者根据血糖水平进一步分为糖耐量正常组、糖调节异常组、糖尿病组,分析甲状腺功能指标与血糖的关系。采用t检验及方差分析进行数据统计。结果亚临床甲状腺功能减退症组口服葡萄糖耐量试验2h血糖明显高于甲状腺功能正常组[（8．34-4．4）vs（7．74-4．2）mmol／L,t=一2．163,P〈0．05],2组糖调节异常及糖尿病的患病率差异无统计学意义。糖尿病组游离甲状腺素水平高于糖调节异常组和糖耐量正常组[分别为（16．8±2．1）、（16．3±2．1）、（16．2±1．9μmol／L,F=10．515,P〈0．01],女性中糖尿病组[15．3％（26／188）]及糖调节异常组[15．0％（34／227）]亚临床甲状腺功能减退症的患病率明显高于糖耐量正常组[9．5％（86／903）]（）（2值分别为7．165、5．685,均P〈0．05）,女性亚临床甲状腺功能减退症的患病率明显高于男性[11．1％（146／1318）VS4．6％（47／1027）,x2=31．852,P〈0．01]。多元线性回归分析显示,校正体质指数、腰围、血压、血脂后,总体受试者空腹血糖与游离甲状腺素呈正相关（β=2．748,P〈0．01）,男性受试者空腹血糖与游离甲状腺素亦呈正相关（口=2．346,P〈0．01）,女性受试者口服葡萄糖耐量试验2h血糖与游离甲状腺素呈正相关（／3=2．748,P〈0．01）。在正常范围内,游离甲状腺素水平越高,糖尿病的患病危险越大[总体：比值比（OR）=1．142,95％可信区间（cl）1．064-1．225,P〈0．01;女性：OR=1．147,95％C11．024-1．284,P〈0．05：男性：OR：1．142,95％C11．035-1．261,P〈0．01]。促甲状腺激素及游离三碘甲状腺原氨酸与糖尿病无关。结论女性糖调节异常和糖尿病患者亚临床甲状腺功能减退症的患病率增高;游离甲状腺素与血糖水平呈正相关,游离甲状腺素越高,糖尿病的患病风险越大。     

Community-based study of the association of subclinical thyroid dysfunction with blood pressure

The relationship between subclinical thyroid dysfunction and blood pressure has been controversial and received unsufficient attention. Thus, we performed a cross-sectional study conducted among 6,992 inhabitants from six districts of Jiangsu Province to investigate the association of subclinical thyroid dysfunction with blood pressure in China. The data from 6,583 subjects (4,115 women and 2,468 men) were included and divided into three groups: euthyroidism (n = 5669, 86.11%), subclinical hyperthyroidism (n = 108, 1.65%), and subclinical hypothyroidism (n = 806, 12.24%). In the groups with subclinical hypothyroidism and hyperthyroidism, systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure were not significantly different from those in the groups with euthyroidism after being adjusted for age, sex, BMI, and smoking status (P > 0.05). More extensively, the SBP and DBP in the group of subclinical hypothyroidism with lower level of TSH (TSH 4.51–10.00 mIU/l, SCH₁) were significantly higher than those of participants with euthyroidism (P < 0.05). Multivariable logistic analysis revealed that subclinical hypothyroidism with lower TSH (TSH 4.51–10.00 mIU/l) was an independent risk factor for increased SBP (OR = 1.28, 95% CI 1.03–1.59, P = 0.028). Similar results could not be found between groups of euthyroid and subclinical hypothyroid with higher level of TSH (TSH > 10 mIU/l, SCH₂). Further subdivision of the euthyroid group on the basis of a TSH cut-off of 2.5 mIU/l, revealed still no significant difference in blood pressure after adjustment regardless of whether the TSH levels were in the lower reference (TSH 0.40–2.50 mIU/l, n = 4093) or in the upper reference ranges (TSH 2.51–4.50 mIU/l, n = 1576) (P > 0.05). We concluded that subclinical thyroid dysfunction was not associated with blood pressure. Neither subclinical hyperthyroidism nor subclinical hypothyroidism independently predicted increased blood pressure.     

Clinical and subclinical cardiovascular disease in female SLE patients: Interplay between body mass index and bone mineral density

Background and aims

Since accelerated atherosclerosis has been reported in systemic lupus erythematosus (SLE), predictive biomarkers of cardiovascular disease (CVD) are needed. Among non-traditional risk factors, bone mineral density (BMD) has been related to CVD. However, its role in SLE remains controversial. This study aims to analyze the associations of subclinical atherosclerosis with traditional and non-traditional CV risk factors.

亚临床甲状腺功能减退与冠心病及其危险因素之间关系的研究进展

亚临床甲状腺功能减退症（subclinical hypothyroidism）是指血清促甲状腺激素（thyroid-stimulating hormone,TSH）水平升高,血清游离甲状腺素（free thyroxine,FT4）和游离三碘甲腺原氨酸（free triiodothyronine,FT3）水平正常,患者没有或几乎没有甲状腺功能减退的相应症状和体征的甲状腺疾病,简称亚临床甲减[1],好发于老年及女性[2,3],临床症状不典型或缺乏,诊断有赖于实验室检查.     

Determinants of subclinical diabetic heart disease

Aims/hypothesis Subclinical left ventricular (LV) dysfunction has been shown by tissue Doppler and strain imaging in diabetic patients in the absence of coronary disease or LV hypertrophy, but the prevalence and aetiology of this finding remain unclear. This study sought to identify the prevalence and the determinants of subclinical diabetic heart disease.Methods A group of 219 unselected patients with type 2 diabetes without known cardiac disease underwent resting and stress echocardiography. After exclusion of coronary artery disease or LV hypertrophy, the remaining 120 patients (age 57±10 years, 73 male) were studied with tissue Doppler imaging. Peak systolic strain of each wall and systolic (Sm) and diastolic (Em) velocity of each basal segment were measured from the three apical views and averaged for each patient. Significant subclinical LV dysfunction was identified according to Sm and Em normal ranges adjusted by age and sex. Strain and Em were correlated with clinical, therapeutic, echocardiographic and biochemical variables, and significant independent associations were sought using a multiple linear regression model.Results Significant subclinical LV dysfunction was present in 27% diabetic patients. Myocardial systolic dysfunction by peak strain was independently associated with glycosylated haemoglobin level (p<0.001) and lack of angiotensin-converting enzyme inhibitor treatment (p=0.003). Myocardial diastolic function (Em) was independently predicted by age (p=0.013), hypertension (p=0.001), insulin (p=0.008) and metformin (p=0.01) treatment.Conclusions/interpretation In patients with diabetes mellitus, subclinical LV dysfunction is common and associated with poor diabetic control, advancing age, hypertension and metformin treatment; ACE inhibitor and insulin therapies appear to be protective.