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中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2016, Vol. 02 ›› Issue (04) : 230 -236. doi: 10.3877/cma.j.issn.2095-9605.2016.04.010

所属专题： 文献；

循证医学

甲状腺功能亢进症与卒中发病相关性：一项基于前瞻性队列研究的Meta分析
李灿锥1, 李朝晖1,†(), 周强1, 罗志伟1   
  1. 1. 519000　广东，暨南大学附属珠海医院神经内科
  • 收稿日期:2016-07-15 出版日期:2016-11-30
  • 通信作者: 李朝晖
  • 基金资助:
    2013年度脑卒中高危人群筛查和干预项目(国卫脑防委函[2013]55号)

Correlation between hyperthyroidism and risk of stroke: a meta-analysis based on prospective cohort studies

Canzhui Li1, Zhaohui Li1,†(), Qiang Zhou1, Zhiwei Luo1   

  1. 1. Zhuhai Hospital Affiliated to Jinan University, Zhuhai 519000, China
  • Received:2016-07-15 Published:2016-11-30
  • Corresponding author: Zhaohui Li
  • About author:
    Corresponding author: Li Zhaohui, Email:
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引用本文：

李灿锥, 李朝晖, 周强, 罗志伟. 甲状腺功能亢进症与卒中发病相关性：一项基于前瞻性队列研究的Meta分析[J]. 中华肥胖与代谢病电子杂志, 2016, 02(04): 230-236.

Canzhui Li, Zhaohui Li, Qiang Zhou, Zhiwei Luo. Correlation between hyperthyroidism and risk of stroke: a meta-analysis based on prospective cohort studies[J]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2016, 02(04): 230-236.

目的

探讨甲状腺功能亢进症（HT）与卒中发病的相关性。

方法

中文以"甲状腺功能亢进症" "卒中" "脑梗死" ，英文以"thyroid dysfunction" "thyroid disorder" "thyroid disease" "hyperthyroidism" "thyrotoxicosis" "stroke" "cerebrovascular disease" "cerebrovascular accident"为检索词。计算机检索Pubmed、EMbase、Google Scholar、中国期刊全文数据库（CNKI）、中国生物医学文献数据库（CBM）、万方数字化期刊全文数据库，并手工检索相关杂志。由2位研究者按照纳入和排除标准筛选文献，并进行资料提取，当意见不统一时，交由第3位研究者决定。采用Newcastle-Ottawa Scale（NOS）文献质量评价量表对符合纳入标准的文献进行质量评价，并采用Stata 12.0软件对纳入文献的结局指标进行Meta分析。

结果

共纳入11项前瞻性队列研究，NOS量表评分提示均为质量较高文献。Meta分析结果表明：HT患者发生卒中的风险是甲状腺功能正常（ET）人群的1.30倍（P<0.05）。亚组分析结果表明，亚洲地区的HT患者发生卒中的风险是亚洲ET人群的1.39倍（P<0.05)；甲亢类型属于临床HT的患者发生卒中的风险是ET人群的1.32倍（P<0.05）；不伴有心房颤动的HT患者发生卒中的风险是ET人群的1.33倍（P<0.05)。对校正了大多数混杂因素的研究进行的亚组分析表明，HT患者发生卒中的风险是ET人群的1.35倍（P<0.05)。Begg和Egger检验均表明无发表偏倚可能，剪补法校正后RR为1.26。敏感性分析提示本次研究结果稳定。

结论

HT可能为卒中发病的一个危险因素，鉴于本研究的局限性，需要进一步开展相关研究进行验证。

关键词: 甲状腺功能亢进症, 卒中, 心房颤动, Meta分析
Objective

To investigate the correlation between hyperthyroidism (HT) and stroke.

Methods

The search terms included "hyperthyroidism" "stroke" and "cerebral infarction" in both Chinese and English, and "thyroid dysfunction" "thyroid disorder" "thyroid disease" "thyrotoxicosis" "cerebrovascular disease" and "cerebrovascular accident" in English. PubMed, Embase, Google Scholar, CNKI, CBM and Wanfang were searched, and the related magazines were also hand-searched. These studies were selected and related data were extracted by two authors according to the inclusion and exclusion criteria, and a third author would make a decision when the former two authors couldn't reach an agreement. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included studies, and the Stata 12.0 software was used for meta-analysis.

Results

Eleven prospective cohort studies were included. The NOS scores indicated that all the studies were high-quality studies. The meta-analysis showed that the risk of stroke in the HT group is 1.30 times as high as that in the euthyroidism (ET) group (P<0.05). Subgroup analyses showed that among Asian populations, the risk of stroke in the HT group is 1.39 times as high as that in the ET group (P<0.05); the risk of stoke in the clinical HT group is 1.32 times as high as that in the ET group (P<0.05 ); and the risk of stroke in the HT group without atrial fibrillation is 1.33 times as high as that in the ET group (P<0.05). In addition, the subgroup analysis of studies which had adjusted most of confounding factors showed that the risk of stroke in the HT group was 1.35 times as high as that in the ET group (P<0.05). Begg and Egger tests both showed that there were no published biases, and the RR value was 1.26 after conducting a trim and fill analysis. Sensitivity analysis indicated that the results were stable.

Conclusion

HT might be a risk factor of stroke, but due to the limitations of this meta-analysis, further relevant research is warranted for validation.

Key words: Hyperthyroidism, Stroke, Atrial fibrillation, Meta-analysis
图1 文献检索筛选流程图
表1 纳入研究的一般情况
纳入研究 发表年份（年） 地区 样本量（例） 平均年龄（岁） 随访时间（年） 暴露组（例） 非暴露组（例） 是否合并房颤 结局指标 校正的混杂因素
临床HT SHT
Parle等[10] 2001 英国 1 191 67.9 8.3±1.8 – 70 1 026 否 致死性卒中 性别、年龄
Qureshi等[11] 2006 美国 5 269 48±14 20 34 – 4 776 否 卒中 性别、年龄、种族、吸烟、糖尿病、收缩压、血脂、体质指数
Cappola等[12] 2006 美国 3 233 72.7±5.6 12.5 – 47 2 639 否 卒中/TIA 性别、年龄、种族、吸烟、糖尿病、高血压病、低密度脂蛋白水平
Siu等[13] 2009 中国香港 480 64.7±3.3 1 320 – 160 是 缺血性卒中 性别、年龄
Sheu等[14] 2010 中国台湾 28 584 32.1±7.4 5 3 176 – 25 408 否 缺血性卒中 性别、年龄、房颤、收入、居住地区、高血压病、糖尿病、体质指数
Schultz等[15] 2011 丹麦 605 67.9 5 – 25 549 否 卒中 性别、年龄、吸烟、高血压病、糖尿病
Friberg等[16] 2012 瑞典 90 490 76.2 1.5 –a – – 是 缺血性卒中 性别、年龄
Chen等[17] 2014 中国 269 57.8±2.5 3 162 – 107 是 缺血性卒中 性别、年龄、高血压病、糖尿病、慢性心力衰竭
Yang等[18] 2014 中国台湾 68 462 41.2±14.7 2 8 698 – 26 621 否 卒中 性别、年龄、糖尿病、高血压病、肾功能不全
Bruere等[19] 2015 法国 8 692 71±14 2.6 141 – 8 281 是 卒中/系统性栓塞 性别、年龄
Martin等[20] 2015 美国 11 359 57±6 20 204 374 9 984 否 卒中 性别、年龄、吸烟、酗酒、糖尿病、血压、房颤、血脂、体质指数
表2 纳入研究的NOS文献质量评价量表质量评价（分）
纳入研究 研究对象 可比性 结局 总得分
暴露队列代表性 非暴露队列选择 暴露确定 研究前是否发生结局事件 是否控制了重要的混杂因素 结局事件评估 随访是否充分 随访的完整性
Parle等 1 1 1 1 1 1 1 0 7
Qureshi等 1 1 1 1 2 1 1 1 9
Cappola等 1 1 1 0 2 1 1 0 7
Siu等 1 1 1 1 1 1 0 1 7
Sheu等 1 1 1 1 2 1 1 0 8
Schultz等 1 1 1 0 2 1 1 1 8
Friberg等 1 1 1 0 1 1 0 1 6
Chen等 1 1 1 0 2 1 1 1 8
Yang等 1 1 1 1 2 1 0 1 8
Bruere等 1 1 1 1 1 1 1 0 7
Martin等 1 1 1 0 2 1 1 0 7
图2 HT与卒中发生风险相关性的森林图
图3 异质性检验的Galbraith图
图4 各亚组患者与卒中发生相关性的森林图
图5 HT与卒中发生相关性的漏斗图
图6 Begg和Egger检验结果
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