甲状腺功能减退症与卒中发病的meta分析
A meta-analysis on hypothyroidism and the risk of stroke

目的:评估甲状腺功能减退症(甲减)与卒中发病的关系。方法:检索Pubmed、Embase、Medline、Google Scholar、Cochrane Library、Web of Science、CNKI、维普和万方数据库有关甲减与卒中关系的病例对照研究和队列研究,由2名研究员独立筛选文献及提取资料,对纳入文献采用NOS量表进行质量评价,应用Stata 12.0进行统计分析。结果:共纳入11篇相关文献(9篇队列研究,2篇病例对照研究),累积样本量238 916例,发生卒中事件6 026例。结果显示,与甲状腺功能正常者相比,甲减患者具有较高的卒中发病风险(RR=1.24,95%CI=1.02～1.52)。Meta回归分析结果提示地区和平均年龄为可能的异质性因素(P均<0.05)。亚组分析结果提示平均年龄<65岁的甲减患者卒中发病风险较甲状腺功能正常者高(RR=1.44,95%CI=1.02～2.04),但平均年龄<65岁的研究间存在较高的异质性; 基于亚洲人群亚组研究的异质性较欧洲和美洲高。敏感性分析提示本研究结果稳健性较好。本研究无明显发表偏倚。结论:甲减可能增加卒中的发病风险,平均年龄<65岁的甲减患者可能有着更高的卒中发病风险。
Aim: To evaluate the association between hypothyroidism and the risk of stroke.Methods: Published cohort studies and case-control studies on association between hypothyroidism and the risk of stroke were identified through a systematic search in Pubmed,Embase,Medline,Google Scholar, Cochrane Library,Web of Science,CNKI,VIP and Wanfang database.Articles were screened and data were extracted by two independent reviewers.Articles' quality was assessed using NOS scale. Stata 12.0 was used for data analysis.Results: Eleven studies(9 cohort studies and 2 case-control studies),including 238 916 participants with 6 026 stroke events were involved totally.Compared with the euthyroid group,patients with hypothyroidism had a higher risk of stroke[RR(95%CI)=1.24(1.02-1.52)].Meta-regression analysis showed that mean age and region may be potential sources of heterogeneity.Subgroup analysis indicated that hypothyroidism increased the risk of stroke in the population with mean age less than 65 years[RR(95%CI)=1.44(1.02-2.04)], but there was higher heterogeneity.Compared with Europe and America subgroups,the studies from Asia had higher heterogeneity.The results were stable indicated by sensitivity analysis without obvious publication bias.Conclusion: Hypothyroidism may lightly increase the risk of stroke,mainly influence subjects younger than 65 years