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Updated: Jun 9, 2025

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在患有亚临床甲状腺功能低下症的患者中,甲状腺功能类别的变化随着时间的推移:系统性审查和元分析
Xueqi Zhang1, Guofeng Zhang1, Songwen Wang1
1Department of Endocrinology and Metabolism, Institute of Endocrine, NHC Key Laboratory of Diagnosis and Treatment of Thyroid Diseases, The First Hospital of China Medical University, Shenyang, 110001, People's Republic of China.
BMC endocrine disorders
|October 26, 2024
概括
亚临床甲状腺功能低下症 (SCH) 通常会自然消失,但较高的TSH水平 (≥10 mU/L) 或阳性甲状腺过氧化酶抗体 (TPOAb) 会增加明显甲状腺功能低下症的风险. 建议对这些患者进行密切监测.
科学领域:
- 内分泌学 在内分泌学.
- 内部医学 内部医学
- 甲状腺学 甲状腺学
背景情况:
- 亚临床甲状腺功能低下症 (SCH) 定义为甲状腺刺激激素 (TSH) 的升高与正常的自由甲状腺素 (FT4).
- 了解SCH结果对于临床管理和治疗决策至关重要.
研究的目的:
- 综合从前性研究中关于SCH自然进展的发现.
- 为了确定影响甲状腺功能变化的因素,SCH患者随着时间的推移.
- 为SCH.提供临床诊断和治疗策略的证据.
主要方法:
- 在PubMed,Embase,Cochrane图书馆和科学网上进行了系统的文献搜索.
- 包括公布到2024年9月的SCH结果的前性后续研究.
- 进行了元分析,以计算整体风险比率 (RR) 和95%置信区间 (CI).
主要成果:
- 对1859人进行的8项研究的分析表明,TSH≥10mU/L的SCH患者显著更有可能发展明显的甲状腺功能低下症 (RR 11.38),并且更不可能使TSH正常化 (RR 0.20).
- 对甲状腺过氧化酶抗体 (TPOAb) 阳性测试的患者显示,进展到明显的甲状腺功能低下症的风险更高 (RR 2.53) 和返回甲状腺功能低下症的可能性更低 (RR 0.68).
- 很大一部分SCH患者自然恢复到正常的TSH水平或保持在SCH状态.
结论:
- 许多亚临床甲状腺功能低下症病例会自发消失或在没有进展的情况下持续存在.
- 提升的TSH水平 (≥10 mU/L) 和阳性TPOAb是增加进展到明显甲状腺功能低下症风险的关键指标.
- 在SCH的自然结果中没有观察到基于性别的显著差异,这需要进一步调查特定的风险因素.
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