The prognostic impact of thyroid function in pulmonary hypertension
The prognostic impact of thyroid function in pulmonary hypertension
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DOI：
10.1016/j.healun.2016.05.022
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发表时间：
2016-12-01
影响因子：
8.9
通讯作者：
Gall, Henning
中科院分区：
文献类型：
--
作者：
Richter, Manuel. J.;Sommer, Natascha;Gall, Henning
背景：甲状腺疾病在肺动脉高压（PH）患者中很常见，但其对长期生存的影响尚不清楚。我们检查了游离三碘甲状腺原氨酸（173）和游离甲状腺素和促甲状腺激素（TSH）的甲状腺激素水平以及PH中甲状腺激素替代（THR）治疗的预后意义。方法：我们对1999年至2013年吉森PH登记处招募的1，756例患者进行了回顾性分析，基线甲状腺功能数据;其中，355例、533例、498例和370例患有肺动脉高压（PAH）;分别包括192例特发性PAH（iPAH）、左心疾病所致PH、肺部疾病所致PH和慢性血栓栓塞性PH（CTEPH）。采用考克斯回归和Kaplan-Meier分析确定与死亡率相关的甲状腺功能参数。结果：1年、3年和5年的无移植生存率分别为86.7%、65.6%和53.0%。未进行THR治疗是iPAH患者死亡的独立预测因素（多变量风险比11412，2.50; 95%置信区间[CI]，1.06-5.75）。在未接受THR治疗的患者中，最低和最高四分位数的TSH水平（与中间2个四分位数相比）独立预测iPAH中的死亡（HR，1.98; 95% CI，1.07-3.67），而fT 3水平降低与PAH死亡增加独立相关（HR，8.30; 95%CI，2.50-25.00）和CTEPH（HR，1.79; 95%CI，1.14-4.20）。结论：甲状腺激素水平和THR治疗是iPAH、PAH和CTEPH的预后因素。前瞻性研究是必要的，以验证甲状腺功能的预后意义和THR治疗在PH中的作用。（C）2016年国际心肺移植学会。All rights reserved.
BACKGROUND: Thyroid disease is common in patients with pulmonary hypertension (PH), but its effect on long-term survival remains unknown. We examined the prognostic significance of thyroid hormone levels of free triiodothyronine (173) and free thyroxine and thyroid-stimulating hormone (TSH), and thyroid hormone replacement (THR) therapy in PH.METHODS: We conducted a retrospective analysis of 1,756 patients enrolled in the Giessen PH Registry in 1999 to 2013 with baseline thyroid function data; of these, 355, 533, 498, and 370 had pulmonary arterial hypertension (PAH); including 192 with idiopathic PAH (iPAH), PH due to left heart disease, PH due to lung diseases, and chronic thromboembolic PH (CTEPH), respectively. Thyroid function parameters associated with mortality were identified using Cox regression and Kaplan-Meier analyses.RESULTS: Transplant-free survival at 1, 3, and 5 years was 86.7%, 65.6%, and 53.0%, respectively. Absence of THR therapy was an independent predictor of death in iPAH (multivariate hazard ratio 11412), 2.50; 95% confidence interval [Cl], 1.06-5.75). In patients without THR therapy, TSH levels in the lowest and highest quartiles (compared with the middle 2 quartiles) independently predicted death in iPAH (HR, 1.98; 95% CI, 1.07-3.67), whereas reduced fT3 levels were independently associated with increased death in PAH (HR, 8.30; 95% CI, 2.50-25.00) and CTEPH (HR, 1.79; 95% CI, 1.14-4.20).CONCLUSIONS: Thyroid hormone levels and THR therapy are prognostic factors in iPAH, PAH, and CTEPH. Prospective studies are warranted to verify the prognostic significance of thyroid function and the effect of THR therapy in PH. (C) 2016 International Society for Heart and Lung Transplantation. All rights reserved.