老年人甲状腺功能异常与心血管疾病

Thyroid dysfunction and cardiovascular disease in the elderly

摘要:

甲状腺功能异常与心血管疾病密切相关。老年人促甲状腺激素分布曲线向高水平方向偏移，因此，需应用年龄特异的参考范围判断甲状腺功能状态。近来，亚临床甲状腺疾病日益得到重视。研究表明亚临床甲状腺功能亢进（亚甲亢）可引起心脏结构和功能的改变，可引起房颤的发生率增加。而亚临床甲状腺功能减退（亚甲减）可能是心力衰竭、缺血性心脏病、全因死亡的一个潜在危险。异常甲状腺功能经纠正后，与甲亢和甲减相关的心血管疾病可得到缓解。基于老老年患者中亚临床甲减可能有保护作用，因此，亚临床甲状腺功能异常对心血管疾病的影响以及何种患者经过治疗可以获益，需要更多的循证医学的证据用以指导临床实践。

Abstract:

Thyroid dysfunctions have close relationship with cardiovascular diseases. As thyrotropin distribution shifts progressively toward higher levels with age, specific reference ranges for thyroid function tests should be established for the elderly. Recently, more and more attention is paid to subclinical thyroid diseases. Some evidence shows that subclinical hyperthyroidism exerts important effects on cardiac structure and functions, and it also increases the risk of atrial fibrillation. However, subclinical hypothyroidism might be a potential risk factor for heart failure, ischemic heart disease and all-cause mortality, although it is still controversial. Cardiovascular disease associated with hyper- and hypothyroidism will be improved when thyroid function returns to normal. Since physiologically decreased thyroid activity to some extent might have favorable effects in the very old patients, more clinical evidence should be provided to illuminate the effects of subclinical thyroid dysfunction on cardiovascular diseases; and large, randomized clinical trials are needed to identify the target populations of individuals with subclinical thyroid dysfunction who will be benefited after thyroid treatment.