PDF(Pubmed)
Abstract：
UNASSIGNED: Subclinical hypothyroidism (SCH) often leads to alterations in lipid profile, which may negatively impact humans health. Whether lipids in turn affect the natural history of SCH is unknown. We aimed to assess the association between longitudinal changes in serum lipid levels and the natural history of SCH.
UNASSIGNED: This retrospective cohort study using data from the REACTION study included 581 patients with SCH who were enrolled between July 1, 2011, and December 19, 2014, with a median follow-up of three [IQR, 2·86-3·21] years. Patients with missing data or conditions that can affect thyroid function were excluded. Changes in serum lipid levels were calculated from serum lipid measurements 3 years apart and classified in two ways: 1) the first, second, and third tertiles of the difference between baseline and follow-up and 2) the percent change from baseline, namely, serum lipid decrease ≥ 25%, minor change, and serum lipid increase ≥ 25%. The natural history of SCH includes regression to euthyroidism, SCH persistence, or progression to overt hypothyroidism (OH). Odds ratios (ORs) were estimated by multivariable logistic regression. Validation was performed on data from a health management cohort study conducted from January 1, 2012, to December 31, 2016, with a median follow-up of two [IQR, 1·92-2·08] years. After using the same inclusion and exclusion criteria as the REACTION cohort study, 412 patients with SCH were eligible for the validation analysis.
UNASSIGNED: There were 132 (22·7%) men and 449 (77·3%) women in the study, with a median age of 56 [IQR,49-62] years. During follow-up, 270 (46·5%), 266 (45·8%), and 27 (4·6%) patients had regression to euthyroidism, persistent SCH, and progression to OH, respectively. Both grouping manners showed a significant association between changes in lipid levels and the natural history of SCH. A total cholesterol (TC)-level increase was independently associated with a greater risk of progression to OH (OR for ≥ 25% TC increase vs. minor change: 5·40; 95% CI 1·46-21·65), whereas TC-level declines increased the likelihood of regressing to euthyroidism (OR for ≥ 25% TC decrease vs. minor change: 3·45; 95% CI 1·09-12·43). Similarly, the likelihood of regression according to changes in triglyceride (TG) levels exhibited a consistent trend with that according to TC-level changes. A similar pattern of association was observed in the validation cohort.
UNASSIGNED: Changes in serum lipid levels in SCH are associated with future progression or regression risk, suggesting that the changes in serum lipid levels may affect the natural history of SCH. Clinicians should pay attention to the long-term control of serum lipids levels in populations with SCH, which may benefit thyroid function.
UNASSIGNED: This work was supported by grants from the National Key Research and Development Program of China (2017YFC1309800), the National Natural Science Foundation (81430020, 82070818), and the \"Outstanding University Driven by Talents\" Program and Academic Promotion Program of Shandong First Medical University (2019LJ007).
UNASSIGNED: This retrospective cohort study using data from the REACTION study included 581 patients with SCH who were enrolled between July 1, 2011, and December 19, 2014, with a median follow-up of three [IQR, 2·86-3·21] years. Patients with missing data or conditions that can affect thyroid function were excluded. Changes in serum lipid levels were calculated from serum lipid measurements 3 years apart and classified in two ways: 1) the first, second, and third tertiles of the difference between baseline and follow-up and 2) the percent change from baseline, namely, serum lipid decrease ≥ 25%, minor change, and serum lipid increase ≥ 25%. The natural history of SCH includes regression to euthyroidism, SCH persistence, or progression to overt hypothyroidism (OH). Odds ratios (ORs) were estimated by multivariable logistic regression. Validation was performed on data from a health management cohort study conducted from January 1, 2012, to December 31, 2016, with a median follow-up of two [IQR, 1·92-2·08] years. After using the same inclusion and exclusion criteria as the REACTION cohort study, 412 patients with SCH were eligible for the validation analysis.
UNASSIGNED: There were 132 (22·7%) men and 449 (77·3%) women in the study, with a median age of 56 [IQR,49-62] years. During follow-up, 270 (46·5%), 266 (45·8%), and 27 (4·6%) patients had regression to euthyroidism, persistent SCH, and progression to OH, respectively. Both grouping manners showed a significant association between changes in lipid levels and the natural history of SCH. A total cholesterol (TC)-level increase was independently associated with a greater risk of progression to OH (OR for ≥ 25% TC increase vs. minor change: 5·40; 95% CI 1·46-21·65), whereas TC-level declines increased the likelihood of regressing to euthyroidism (OR for ≥ 25% TC decrease vs. minor change: 3·45; 95% CI 1·09-12·43). Similarly, the likelihood of regression according to changes in triglyceride (TG) levels exhibited a consistent trend with that according to TC-level changes. A similar pattern of association was observed in the validation cohort.
UNASSIGNED: Changes in serum lipid levels in SCH are associated with future progression or regression risk, suggesting that the changes in serum lipid levels may affect the natural history of SCH. Clinicians should pay attention to the long-term control of serum lipids levels in populations with SCH, which may benefit thyroid function.
UNASSIGNED: This work was supported by grants from the National Key Research and Development Program of China (2017YFC1309800), the National Natural Science Foundation (81430020, 82070818), and the \"Outstanding University Driven by Talents\" Program and Academic Promotion Program of Shandong First Medical University (2019LJ007).
摘要：
未经证实：亚临床甲状腺功能减退症（SCH）常导致血脂改变，这可能会对人类健康产生负面影响。脂质是否反过来影响SCH的自然史尚不清楚。我们旨在评估血清脂质水平的纵向变化与SCH的自然史之间的关联。
UNASSIGNED：这项回顾性队列研究使用了来自REACTION研究的数据，纳入了2011年7月1日至2014年12月19日之间的581例SCH患者，中位随访时间为3[IQR，2·86-3·21]年。排除数据缺失或可能影响甲状腺功能的患者。从相隔3年的血清脂质测量值计算血清脂质水平的变化，并以两种方式分类：1）第一，第二,以及基线和随访之间差异的第三个三分位数，以及2）从基线的百分比变化，即,血脂下降≥25%，微小的变化,和血脂增加≥25%。SCH的自然史包括甲状腺功能恢复，SCH持久性，或进展为明显的甲状腺功能减退症（OH）。通过多变量逻辑回归估计赔率（ORs）。对2012年1月1日至2016年12月31日进行的健康管理队列研究的数据进行了验证，中位随访时间为2[IQR，1·92-2·08]年。在使用与反应队列研究相同的纳入和排除标准后，412例SCH患者符合验证分析的条件。
未经评估：研究中有132名（22·7％）男性和449名（77·3％）女性，平均年龄为56岁[IQR，49-62]年随访期间,270（46·5%），266（45·8%），27例(4.6%)患者甲状腺功能恢复，持久性SCH，进展到OH，分别。两种分组方式均显示脂质水平的变化与SCH的自然史之间存在显着关联。总胆固醇（TC）水平升高与进展为OH的更大风险独立相关（OR≥25％TC升高与微小变化：5·40；95%CI1·46-21·65），而TC水平下降则增加了向甲状腺功能正常消退的可能性(TC下降≥25%与小变化：3·45；95%CI1·09-12·43）。同样，根据甘油三酯(TG)水平变化的回归可能性与根据TC水平变化的回归趋势一致.在验证队列中观察到相似的关联模式。
UNASSIGNED：SCH的血脂水平变化与未来的进展或消退风险相关，提示血脂水平的变化可能会影响SCH的自然史。临床医生应注意SCH患者血脂水平的长期控制,这可能有利于甲状腺功能。
UNASSIGNED：这项工作得到了中国国家重点研究发展计划（2017YFC1309800）的资助，国家自然科学基金(81430020,82070818),和山东第一医科大学“人才驱动卓越大学”计划和学术促进计划（2019LJ007）。
UNASSIGNED：这项回顾性队列研究使用了来自REACTION研究的数据，纳入了2011年7月1日至2014年12月19日之间的581例SCH患者，中位随访时间为3[IQR，2·86-3·21]年。排除数据缺失或可能影响甲状腺功能的患者。从相隔3年的血清脂质测量值计算血清脂质水平的变化，并以两种方式分类：1）第一，第二,以及基线和随访之间差异的第三个三分位数，以及2）从基线的百分比变化，即,血脂下降≥25%，微小的变化,和血脂增加≥25%。SCH的自然史包括甲状腺功能恢复，SCH持久性，或进展为明显的甲状腺功能减退症（OH）。通过多变量逻辑回归估计赔率（ORs）。对2012年1月1日至2016年12月31日进行的健康管理队列研究的数据进行了验证，中位随访时间为2[IQR，1·92-2·08]年。在使用与反应队列研究相同的纳入和排除标准后，412例SCH患者符合验证分析的条件。
未经评估：研究中有132名（22·7％）男性和449名（77·3％）女性，平均年龄为56岁[IQR，49-62]年随访期间,270（46·5%），266（45·8%），27例(4.6%)患者甲状腺功能恢复，持久性SCH，进展到OH，分别。两种分组方式均显示脂质水平的变化与SCH的自然史之间存在显着关联。总胆固醇（TC）水平升高与进展为OH的更大风险独立相关（OR≥25％TC升高与微小变化：5·40；95%CI1·46-21·65），而TC水平下降则增加了向甲状腺功能正常消退的可能性(TC下降≥25%与小变化：3·45；95%CI1·09-12·43）。同样，根据甘油三酯(TG)水平变化的回归可能性与根据TC水平变化的回归趋势一致.在验证队列中观察到相似的关联模式。
UNASSIGNED：SCH的血脂水平变化与未来的进展或消退风险相关，提示血脂水平的变化可能会影响SCH的自然史。临床医生应注意SCH患者血脂水平的长期控制,这可能有利于甲状腺功能。
UNASSIGNED：这项工作得到了中国国家重点研究发展计划（2017YFC1309800）的资助，国家自然科学基金(81430020,82070818),和山东第一医科大学“人才驱动卓越大学”计划和学术促进计划（2019LJ007）。
