Bile duct stone procedures are more frequent in patients with hypothyroidism. A large, registry-based, cohort study in Finland
Bile duct stone procedures are more frequent in patients with hypothyroidism. A large, registry-based, cohort study in Finland
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DOI：
10.3109/00365520903386721
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发表时间：
2010-01-01
影响因子：
1.9
通讯作者：
Nordback, Isto
中科院分区：
文献类型：
--
作者：
Laukkarinen, Johanna;Sand, Juhani;Nordback, Isto
客观的。胆汁流动延迟可能会导致胆总管结石（CBDS）的形成/积累。甲状腺功能减退症时胆汁流动延迟，部分原因是奥迪括约肌松弛不足。与健康对照者和胆囊结石患者相比，CBDS 患者临床和亚临床甲状腺功能减退症的发生率较高。这项基于登记的大型研究的目的是调查与年龄、性别和居住区域调整的青光眼（对照）患者相比，诊断为甲状腺功能减退症的患者中 CBDS 的患病率。材料和方法。 1987 年至 200 1 年间，所有获得批准的甲状腺功能减退或青光眼特殊医疗保险 (SMC) 且未获得其他 SMC 批准的患者均被纳入其中。青光眼（对照）队列根据年龄、性别和居住地区进行调整。对于每位患者，记录 SMC 的发作、所有处方药和 CBDS 治疗。结果。每组共有 14,334 名患者符合纳入标准。甲状腺功能减退症队列中有 33 名患者 (0.23%) 和青光眼队列中有 23 名患者 (0.16%) 接受过 CBDS 治疗 (p = 0.018)。在诊断出甲状腺功能减退症或青光眼之前，各组的 CBDS 治疗次数没有差异。然而，在诊断出甲状腺功能减退或青光眼后，甲状腺功能减退队列中的 CBD 结石患者 (n = 25) 明显多于青光眼队列 (n = 14) (p < 0.05)。结论。诊断的甲状腺功能减退症是 CBDS 的一个重要危险因素。我们假设 CBD 结石形成是在未治疗期间开始的，甚至在开始用药后也会发展/成熟，这提出了这方面治疗效率的问题。在治疗 CBDS 患者时，应该意识到可能存在甲状腺功能减退的背景。
Objective. Delayed bile flow may induce the formation/accumulation of common bile duct stones (CBDS). Bile flow is delayed in hypothyroidism, partly due to insufficient sphincter of Oddi relaxation. Patients with CBDS have higher incidences of clinical and subclinical hypothyroidism compared to healthy controls and gallbladder stone patients. The aim of this large registry-based study was to investigate the prevalence of CBDS in patients with diagnosed hypothyroidism compared to age-, sex- and living area-adjusted glaucoma (control) patients. Material and methods. Between 1987 and 200 1, all patients with approved Special Medical Coverage (SMC) for hypothyroidism or glaucoma, and without other SMC approvals, were included. The glaucoma (control) cohort was adjusted for age, sex and area of residence. For each patient, onset of SMC, all prescription drugs and treatments for CBDS were noted. Results. A total of 14,334 patients in each group met the inclusion criteria. Thirty-three patients (0.23%) in the hypothyroidism cohort and 23 (0.16%) in the glaucoma cohort had been treated for CBDS (p = 0.018). The groups did not differ in the number of CBDS treatments before the diagnosis of hypothyroidism or glaucoma. However, after the diagnosis of hypothyroidism or glaucoma there were significantly more CBD stone patients in the hypothyroid cohort (n = 25) than in the glaucoma cohort (n = 14) (p < 0.05). Conclusions. Diagnosed hypothyroidism is a significant risk factor for CBDS. We hypothesize that CBD stone formation begins during the untreated period and develops/matures even after the medication has been initiated, raising the question of the efficiency of treatment in this respect. When treating CBDS patients, one should be aware of the possible hypothyroid background.