目的:甲状腺风暴是甲状腺毒症最严重的表现。β受体阻滞剂是这种情况的标准治疗方案之一,普萘洛尔是历史上首选的选择。然而,日本甲状腺协会和日本内分泌学会发布的2016年指南建议使用β-1选择性β受体阻滞剂而非选择性β受体阻滞剂。如普萘洛尔。然而,支持这一建议的证据有限.在这里,我们旨在根据β受体阻滞剂的选择,调查甲状腺风暴患者的院内死亡率.
方法:回顾性队列研究。
方法:诊断程序组合数据库,日本的全国住院数据库。
方法:2010年4月至2022年3月期间因甲状腺风暴住院的患者。
方法:使用倾向评分重叠加权比较接受β-1选择性β受体阻滞剂和接受普萘洛尔的患者的住院死亡率。还进行了亚组分析,考虑是否存在急性心力衰竭。
结果:在2462名符合条件的患者中,1452人接受β-1选择性β受体阻滞剂,1010人接受普萘洛尔。β-1选择性β受体阻滞剂组的院内粗死亡率为9.3%,普萘洛尔组为6.2%。调整基线变量后,使用β-1选择性β受体阻滞剂与较低的住院死亡率无关(6.3%vs.7.4%;赔率比,0.85;95%CI,0.57-1.26)。此外,急性心力衰竭患者的院内死亡率无显著差异.
结论:在甲状腺风暴患者中,选择β-1选择性β受体阻滞剂和普萘洛尔并不影响住院死亡率,无论是否存在急性心力衰竭。因此,β-1选择性β受体阻滞剂和普萘洛尔都可以被视为甲状腺疾病患者β受体阻滞剂治疗的可行治疗选择,视临床情况而定。
OBJECTIVE: Thyroid storm is the most severe manifestation of thyrotoxicosis. Beta-blockers are among the standard treatment regimens for this condition, with propranolol being the historically preferred option. However, 2016 guidelines issued by the Japan Thyroid Association and the Japan Endocrine Society recommend the use of beta-1 selective beta-blockers over nonselective beta-blockers, such as propranolol. Nevertheless, evidence supporting this recommendation is limited. Herein, we aimed to investigate the in-hospital mortality of patients with thyroid storms based on the choice of beta-blockers.
METHODS: Retrospective cohort study.
METHODS: The Diagnosis Procedure Combination database, a national inpatient database in Japan.
METHODS: Patients hospitalized with thyroid storm between April 2010 and March 2022.
METHODS: Propensity-score overlap weighting was performed to compare in-hospital mortality between patients who received beta-1 selective beta-blockers and those who received propranolol. Subgroup analysis was also conducted, considering the presence or absence of acute heart failure.
RESULTS: Among the 2462 eligible patients, 1452 received beta-1 selective beta-blockers and 1010 received propranolol. The crude in-hospital mortality rates were 9.3% for the beta-1 selective beta-blocker group and 6.2% for the propranolol group. After adjusting for baseline variables, the use of beta-1 selective beta-blockers was not associated with lower in-hospital mortality (6.3% vs. 7.4%; odds ratio, 0.85; 95% CI, 0.57-1.26). Furthermore, no significant difference in in-hospital mortality was observed in patients with acute heart failure.
CONCLUSIONS: In patients with thyroid storm, the choice between beta-1 selective beta-blockers and propranolol did not affect in-hospital mortality, regardless of the presence of acute heart failure. Therefore, both beta-1 selective beta-blockers and propranolol can be regarded as viable treatment options for beta-blocker therapy in cases of thyroid storm, contingent upon the clinical context.