Subclinical Hypothyroidism and Cognitive Impairment: Systematic Review and Meta-Analysis
Subclinical Hypothyroidism and Cognitive Impairment: Systematic Review and Meta-Analysis
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DOI：
10.1210/jc.2015-2046
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发表时间：
2015-11-01
影响因子：
5.8
通讯作者：
Monzani, Fabio
中科院分区：
文献类型：
--
作者：
Pasqualetti, Giuseppe;Pagano, Gennaro;Monzani, Fabio
背景：亚临床甲状腺功能减退症(ShT)与认知功能障碍或痴呆风险之间的关系尚不明确，尤其是在老年人中，对中枢神经系统功能的评估是具有挑战性的。方法：以认知功能为主要指标，以简易智力状态检查、韦氏成人智力量表和韦氏记忆量表修订分数的差异作为痴呆发生率或患病率的综合终点。结果：13项研究进入元分析。仅在75岁以下的SHT患者中观察到认知改变的显著风险：复合终点优势比(OR)1.56(95%可信区间[CI]1.07-2.27，P=0.02，I-2=82.5%)，痴呆风险OR 1.81(95%CI 1.43-2.28，P<；.01，I-2=35%)。平均血清促甲状腺激素(TSH)水平与复合终点的OR呈正相关。综合终点OR1.26(95%可信区间0.96-1.66，P=0.09，I-2=87.2%)，痴呆风险OR1.42(95%可信区间0.97-2.07，P=0.07，I-2=66.8%)，简易精神状态检查均数差-0.059(95%可信区间-0.464，P=0.78，结论：这项荟萃分析表明，仅在75岁以下和TSH浓度较高的人群中，ShT与认知损害之间存在关系。当将所有研究作为一个整体考虑时，没有发现相关性。老年人缺乏利用与年龄相关的血清TSH参考范围，从而可能误诊为SHT，这可能是原因。
Background: The association between subclinical hypothyroidism (sHT) and cognitive impairment or risk of dementia is not well-defined, especially in the elderly, where the assessment of central nervous system function is challenging. The aim of this systematic review and meta-analysis was to evaluate the possible effect of sHT on cognitive decline and the risk of dementia.Methods: Cognitive function was the primary outcome, evaluated as composite endpoint of incidence or prevalence of dementia or difference of Mini Mental State Examination, Wechsler Adult Intelligence Scale, and Wechsler Memory Scale-Revised scores.Results: Thirteen studies were included in the meta-analysis. A significant risk of cognitive alteration was observed only in sHT individuals younger than age 75 years: composite endpoint odds ratio (OR) 1.56 (95% confidence interval [CI] 1.07-2.27, P = .02, I-2 = 82.5%), risk of dementia OR 1.81 (95% CI 1.43-2.28, P < .01, I-2 = 35%). Mean serum thyroid-stimulating hormone (TSH) levels and the OR of composite endpoint were positively correlated. No significant effect of sHT was found when considering all the studies as a whole: composite endpoint OR 1.26 (95% CI 0.96-1.66, P = .09, I-2 = 87.2%), risk of dementia OR 1.42 (95% CI, 0.97-2.07, P = .07, I-2 = 66.8%), Mini Mental State Examination mean difference -0.059 (95% CI -0.464 to 0.346 P = .78, I-2 = 51.8%).Conclusions: This meta-analysis demonstrates a relationship between sHT and cognitive impairment only in individuals younger than 75 years of age and those with higher TSH concentrations. No correlation was found while considering all the studies as a whole. The lack of utilization of age-related serum TSH reference ranges and consequent potential misdiagnosis of sHT in older people may account for this.