在使用甲状腺激素治疗期间,对心血管和骨健康护理利用的横截面分析
Gustavo C Penna1, Antonio C Bianco1, Matthew D Ettleson1
1Section of Adult and Pediatric Endocrinology, Diabetes & Metabolism, The University of Chicago, Chicago, IL 60637, USA.
The Journal of clinical endocrinology and metabolism
|October 25, 2023
概括
与单独使用LT4相比,Levothyroxine (LT4) 加上Liothyronine (LT3) 和干甲状腺提取物 (DTE) 显示出类似的心血管和骨健康结果. 提供者类型影响了DTE处方.
科学领域:
- 内分泌学 在内分泌学.
- 药理学 药理学是指药理学的学科.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 利沃甲状腺激素 (LT4) 加上利奥甲状腺素 (LT3) 和干甲状腺提取物 (DTE) 占美国新开的甲状腺激素处方的10%以上.
- 这些替代性甲状腺激素疗法经常被处方,需要了解它们的相关健康结果.
研究的目的:
- 为了比较使用LT4+LT3或DTE与LT4单一治疗的患者的心血管疾病 (CVD) 和骨健康 (BH) 的利用情况.
- 为了确定特定的CVD和BH事件的医疗保健资源利用的差异.
主要方法:
- 来自医疗支出小组调查 (2016-2020) 的5437名成年参与者的多年横截面分析.
- 对心房动,心力衰竭,心肌梗塞,中风和骨质疏松症/骨折的门诊,急诊和医院访问的评估.
- 倾向性得分匹配用于平衡治疗组之间的共变量,以便进行可靠的比较.
主要成果:
- 初步分析显示,与LT4用户相比,DTE/LT4+LT3用户的门诊CVD和BH护理利用率较低 (3.5%vs7.7%).
- 两组之间在紧急情况或与医院有关的事件中没有发现显著差异.
- 在倾向分数匹配后,在门诊和住院治疗组中,对心血管疾病和BH事件的医疗保健利用率在所有治疗组中都是相似的.
结论:
- 在对共变量进行调整后,在LT4和DTE/LT4+LT3用户之间没有发现与心血管或骨健康相关的医疗保健利用的显著差异.
- 非医生提供者,如执业护士和替代医学专业人员,更有可能开处方DTE.
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