甲状腺機能は正常範囲内,サブクリニック性甲状腺機能低下,心房細動のリスク
Christine Baumgartner1, Bruno R da Costa2,3, Tinh-Hai Collet4
1Department of General Internal Medicine, Inselspital, Bern University Hospital, (C.B., M.F., C.F., D.A., N.R.).
Circulation
|October 25, 2017
まとめ
通常の範囲内のフリーチロキシン (fT4) 濃度が高いと,心房細動 (AF) のリスクが高まります. 甲状腺刺激ホルモン (TSH) レベルは,この研究でAFリスクと有意な関連性を示さなかった.
科学分野:
- 心臓病科
- 内分泌学
- 流行病学
背景:
- 心房細動 (AF) は,心不全や脳卒中などの重篤な健康問題に関連した一般的な心疾患です.
- 予防策の策定には 変形可能な AFの危険因子の理解が不可欠です
- 甲状腺機能の正常な範囲と甲状腺機能低下の役割は不明でした.
研究 の 目的:
- 甲状腺機能のユータイロイドとサブクリニックの甲状腺機能低下の間の関連性と,先頭葉動 (AF) の発生リスクを調査する.
- 甲状腺刺激ホルモン (TSH) とフリーチロキシン (fT4) のレベルがAF発生率の独立した予測指標であるかどうかを判断する.
主な方法:
- 将来のコホート研究の体系的レビューと個々の参加者のデータメタ解析が行われました.
- 3万人を超える参加者を含む11の集団のデータを分析した.
- ベースラインのTSHとfT4レベルとインシデントAFの関係を評価するために,TSHの範囲に基づいて,ユーチロイドとサブクリニックの甲状腺下位状態を定義するために,コックス比例リスクモデルを使用した.
主要な成果:
- 非甲状腺患者では,フリーチロキシン (fT4) のレベルが高くなり,発作性関節炎のリスクが著しく高まった.
- 甲状腺を刺激するホルモン (TSH) レベルと発症した甲状腺機能低下症の患者において,有意な関連性は認められなかった.
- 心血管疾患を調整したところでも,より高いfT4とAFリスクとの関連は依然として有意であった.
結論:
- ユーチロイドの範囲内の循環中のフリーチロキシン (fT4) のレベルは,心房細動を発症するリスクが高くなります.
- 甲状腺を刺激するホルモン (TSH) レベルは,ユーチロイドとサブクリニックの甲状腺機能低下の範囲の両方で,発生したAFのリスクの増加と関連していないことが判明しました.
- これらの発見は,TSHではなく,fT4レベルが,ユータイロイドの個体におけるAFリスク評価における重要な要因である可能性があることを示唆している.
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