Subclinical hypothyroidism usually is asymptomatic, but it can be associated with various adverse cardiologic outcomes. With the objective of gaining insight into the role of thyroid-stimulating hormone (TSH) in congenital heart abnormalities, this study measured serum TSH concentrations in different subtypes of grown-up congenital heart disease (GUCHD) patients. Serum TSH (reference range, 0.34-5.6 mIU/L), creatinine, cholesterol, C-reactive protein (CRP), N-terminal proB-type natriuretic peptide (NT-pro-BNP), and 24-h proteinuria were measured in 249 GUCHD patients. Of 24 GUCHD patients (9.6 %) with a TSH level higher than 5.6 mUI/L, nine were cyanotic (37.5 %) and seven (29.1 %) had Down syndrome. The GUCHD patients with serum TSH exceeding 5.6 mIU/L had a significantly higher level of serum NT-pro-BNP (195.1 [0.28; 5,280.3] vs 57.6 [0.00; 929.8]; p = 0.001) and CRP (0.30 [0.06; 1.87] vs 0.16 [0.00; 1.40]; p = 0.011] than those with a TSH level of 5.6 mIU/L or lower. No significant differences were found in serum creatinine, lipids, or 24-h proteinuria between the two groups. The T4 concentrations in the GUCHD patients with TSH exceeding 5.6 mIU/L were within the normal range (0.89 ± 0.23 ng/dL). In the multivariate analysis, cyanosis (odds ratio [OR], 6,399; 95 % confidence interval [CI] 2,296-17,830; p < 0.001), Down syndrome (OR, 6,208; 95 % CI, 1,963-19,636; p = 0.002), and NT-pro-BNP concentrations (OR, 1,001; 95 % CI, 1,000-1,002; p < 0.026) proved to be risk factors for TSH levels higher than 5.6 mIU/L. Because subclinical hypothyroidism entails a cardiovascular risk, the authors postulate that TSH screening should be included in the routine follow-up evaluation of GUCHD patients with cyanosis or Down syndrome.

译文

亚临床甲状腺功能减退通常是无症状的,但它可能与各种不良的心脏结局有关。为了深入了解促甲状腺激素 (TSH) 在先天性心脏异常中的作用,本研究测量了成年先天性心脏病 (GUCHD) 患者不同亚型的血清TSH浓度。在249例GUCHD患者中测量了血清TSH (参考范围,0.34-5.6 mIU/L),肌酐,胆固醇,C反应蛋白 (CRP),N末端proB型利钠肽 (NT-pro-BNP) 和24小时蛋白尿。在TSH水平高于5.6 mUI/L的24例GUCHD患者 (9.6% 例) 中,9例为紫绀 (37.5% 例),7例 (29.1% 例) 患有唐氏综合症。血清TSH超过5.6 mIU/L的GUCHD患者的血清NT-pro-BNP水平 (195.1 [0.28; 5,280.3] vs 57.6 [0.00; 929.8]; p = 0.001) 和CRP (0.30 [0.06; 1.87] vs 0.16 [0.00; 1.40]; p = 0.011] 与TSH水平为5.6 mIU/L或更低者比较,血清肌酐、血脂、或两组之间的24小时蛋白尿。TSH超过5.6 mIU/L的GUCHD患者的T4浓度在正常范围内 (0.89 ± 0.23 ng/dL)。在多变量分析中,发绀 (优势比 [or],6,399; 95% 置信区间 [CI] 2,296-17,830; p <0.001),唐氏综合征 (OR,6,208; 95% CI,1,963-19,636; p = 0.002) 和NT-pro-BNP浓度 (OR,1,001; 95% CI,1,000-1,002; p < 0.026) 被证明是TSH水平高于5.6 mIU/L的危险因素。由于亚临床甲状腺功能减退会带来心血管风险,因此作者假设TSH筛查应包括在患有发绀或唐氏综合症的GUCHD患者的常规随访评估中。

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