文章摘要
陈欣,张娜,张文良,时景璞.多普勒超声心动图评价亚临床甲状腺功能减退与左心室功能关系的Meta分析[J].中华流行病学杂志,2011,32(12):1269-1274
多普勒超声心动图评价亚临床甲状腺功能减退与左心室功能关系的Meta分析
Meta-analysis on the association between subclinical hypothyroidism and the left ventricular functions under Doppler echocardiography
收稿日期:2011-06-24  出版日期:2014-09-24
DOI:
中文关键词: 亚临床甲状腺功能减退|左心室舒张功能|左心室收缩功能|Meta分析
英文关键词: Subclinical hypothyroidism| Left ventricular diastolic function| Left ventricular systolic function| Meta-analysis
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作者单位E-mail
陈欣 中国医科大学附属第一医院临床流行病教研室, 沈阳 110001 sjp56@yahoo.com 
张娜 中国医科大学附属第一医院临床流行病教研室, 沈阳 110001  
张文良 中国医科大学附属第一医院临床流行病教研室, 沈阳 110001  
时景璞 中国医科大学附属第一医院临床流行病教研室, 沈阳 110001  
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中文摘要:
      目的应用传统二维多普勒超声心动图定量评价亚临床甲状腺功能减退(亚甲减)与左心室功能的关系.方法检索国内外数据库1999-2011年5月发表的有关亚甲减与左心室功能关系的文献,用左心室射血分数(LVEF)和左心室短轴缩短率(FS)评价左心室收缩功能;以左心室舒张早期血流充盈速度(E)和舒张晚期血流充盈速度(A)及其比值(E/A)、左心室等容舒张时间(IVRT)评价左心室舒张功能.采用Meta分析方法,利用Stata11软件评价亚甲减与左心室收缩和舒张功能的关系.计算各指标的加权均数差(WMD)及其95%CI,并用Begg's检验法评价发表性偏倚.结果共纳入13篇文献.(1)数据合并结果显示,在评价左心室舒张功能的指标中,亚甲减病例组与对照组的A(WMD=4.51,95%CI:2.41~6.61)、E/A(WMD=~0.22,95%CI:-0.30~-0.13)和IVRT(WMD=6.13,95%CI:2.79~9.48)差异均有统计学意义(P<0.05),E的差异无统计学意义(P>0.05);在评价左心室收缩功能的指标中,亚甲减病例组与对照组的LVEF、FS差异均无统计学意义(P>0.05).(2)亚组分析显示,在平均心率(HR)≥72bpm组,亚甲减病例组和对照组的A、E/A和IVRT差异有统计学意义(P<0.05);在<72bpm组,IVRT差异有统计学意义(P<0.05);在平均年龄<60岁组,亚甲减病例组和对照组的A差异有统计学意义(P<0.05).结论亚甲减与左心室舒张功能减退有明显相关性,但与左心室收缩功能减退无明显相关性,提示亚甲减可导致心脏功能的改变,可通过多普勒超声心动图给予评价.
英文摘要:
      Objective To explore the association between subclinical hypothyroidism and the left ventricular functions under conventional 2D Doppler echocardiography and to provide evidence for the protection of heart function.Methods Literatures regarding the association of subclinical hypothyroidism and the left ventricular functions were retrieved in large databases from home and abroad for the last 12 years.The left ventricular systolic function was assessed by left ventricular ejection fraction and the shortening of left ventricular fraction.The left ventricular diastolic function was assessed by left ventricular early diastolic filling flow velocity,late diastolic filling flow velocity,their ratios(E/A),and the left ventricular isovolumic relaxation time.The relationship between subclinical hypothyroidism and the left ventricular functions were assessed by Meta-analysis with Stata 11 software.The weighted mean difference(WMD)and 95% confidence interval(CI)were calculated,and the publication bias was assessed by Begg' s test.Results 1 3 eligible papers were included.(1)Statistics on the combined data showed that in the evaluation of left ventricular diastolic function indicators.There were significant differences in left ventricular late diastolic filling flow velocity(WMD=4.51,95%CI:2.41 to 6.61)and E/A(WMD=-0.22,95%CI:-0.30 to-0.13),as well as the left ventricular isovolumic relaxation time(WM D=6.13,95% CI:2.79 to 9.48)between patients with subclinical hypothyroidism and normal controls but,no significant difference was found in left ventricular early diastolic filling flow velocity.Looking at the left ventricular systolic function indicators.There were no significant differences in the left ventricular ejection fraction and left ventricular fractional shortening between patients with subclinical hypothyroidism and normal controls.(2)Data from the subgroup analysis showed that the differences of left ventricular late diastolic filling flow velocity,E/A and left ventricular isovolumic relaxation time were significantly different between patients with subclinical hypothyroidism and normal controls in the mean heart rate ≥72 bpm group.The difference of left ventricular isovolumic relaxation time was significantly different in the mean heart rate <72 bpm group,and the difference of left ventricular late diastolic filling flow velocity was significant in the mean age <60-year-old group.Conclusion Subclinical hypothyroidism was associated with the left ventricular diastolic dysfunction,but not associated with the left ventricular systolic dysfunction.The results suggested that subclinical hypothyroidism might change the heart function which could be evaluated by Doppler echocardiography.
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