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NEJM:老年亚临床甲状腺功能减退症患者甲状腺激素治疗效果如何?

2017-04-04 xing.T MedSci原创

由此可见,左旋甲状腺素并未为亚临床甲状腺功能减退的老年人提供任何明显的好处。

使用左旋甲状腺素治疗亚临床甲状腺功能减退症是有争议。最近,顶级医学期刊NEJM上发表了一篇研究文章,研究人员旨在确定左旋甲状腺素能否为老年亚临床甲状腺功能减退症患者提供临床益处。

研究人员进行了一项双盲、随机、安慰剂对照、平行组试验,共有737人参加,年龄均在65岁以上,有持续的亚临床甲状腺功能减退症(促甲状腺激素水平为4.60-19.99mIU/L;游离甲状腺素水平在正常范围内)。共有368例患者被分配接受左旋甲状腺素(起始剂量为50μg每天,如果体重小于50kg或患有冠心病则改为25μg每天),根据促甲状腺素水平调整剂量;369例患者被分配接受安慰剂,并进行模拟剂量调整。两个主要结局为1年后甲状腺相关生活质量问卷中甲状腺机能减退症状评分和疲劳评分的变化(每个评分范围是0到100,分数越高分别表示更多的症状或疲劳越严重;最小临床重要差异为9分)。

患者平均年龄为74.4岁,女性为396例(53.7%)。基础平均(±SD)促甲状腺素水平为6.40±2.01mIU/L;1年后,这一水平在安慰剂组已经下降到5.48 mIU/L,相比于左旋甲状腺素组为3.63 mIU/L(P<0.001),在中位剂量50μg水平,研究人员发现1年平均甲状腺功能减退的症状评分(安慰剂组为0.2±15.3 vs. 左旋甲状腺素组为0.2±14.4;组间差异为0;95%可信区间[CI]为-2到2.1)和疲劳评分(3.2±17.7 vs. 3.8±18.4;组间差异为0.4;95%CI为-2.1到2.9)没有显著改变。左旋甲状腺激素组没有观察到有益的次要结局。

由此可见,左旋甲状腺素并未为亚临床甲状腺功能减退的老年人提供任何明显的好处。

原始出处:

David J. Stott,et al. Thyroid Hormone Therapy for Older Adults with Subclinical Hypothyroidism. N Engl J Med. 2017;http://www.nejm.org/doi/full/10.1056/NEJMoa1603825

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    2017-05-02 laoli

    学习了,谢谢分享!

    0

  3. 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createdTime=Wed Apr 05 01:20:16 CST 2017, time=2017-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=185219, encodeId=95b71852198c, content=那最后没有好处,临床上我们就不用了吗?, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83er7lBrMCuvxicCR3XJQhu2X3SmEzicSFDknz19Vav0ln3PHYSicIKQRIiazzcibtEchpeQNrjh2jfOYC0w/132, createdBy=eb931929187, createdName=美丽明天在等我, createdTime=Wed Apr 05 00:38:08 CST 2017, time=2017-04-05, status=1, ipAttribution=)]
    2017-04-06 qjzhai1623

    学习新知识

    0

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createdTime=Wed Apr 05 01:20:16 CST 2017, time=2017-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=185219, encodeId=95b71852198c, content=那最后没有好处,临床上我们就不用了吗?, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83er7lBrMCuvxicCR3XJQhu2X3SmEzicSFDknz19Vav0ln3PHYSicIKQRIiazzcibtEchpeQNrjh2jfOYC0w/132, createdBy=eb931929187, createdName=美丽明天在等我, createdTime=Wed Apr 05 00:38:08 CST 2017, time=2017-04-05, status=1, ipAttribution=)]
    2017-04-05 186****0580(小山羊)

    学习了谢谢了。

    0

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createdTime=Wed Apr 05 01:20:16 CST 2017, time=2017-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=185219, encodeId=95b71852198c, content=那最后没有好处,临床上我们就不用了吗?, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83er7lBrMCuvxicCR3XJQhu2X3SmEzicSFDknz19Vav0ln3PHYSicIKQRIiazzcibtEchpeQNrjh2jfOYC0w/132, createdBy=eb931929187, createdName=美丽明天在等我, createdTime=Wed Apr 05 00:38:08 CST 2017, time=2017-04-05, status=1, ipAttribution=)]
    2017-04-05 虈亣靌

    这篇文章对我有用,值得收藏!

    0

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createdTime=Wed Apr 05 01:20:16 CST 2017, time=2017-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=185219, encodeId=95b71852198c, content=那最后没有好处,临床上我们就不用了吗?, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83er7lBrMCuvxicCR3XJQhu2X3SmEzicSFDknz19Vav0ln3PHYSicIKQRIiazzcibtEchpeQNrjh2jfOYC0w/132, createdBy=eb931929187, createdName=美丽明天在等我, createdTime=Wed Apr 05 00:38:08 CST 2017, time=2017-04-05, status=1, ipAttribution=)]
    2017-04-05 飛歌

    学习了很有用

    0

  10. 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createdTime=Wed Apr 05 01:20:16 CST 2017, time=2017-04-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=185219, encodeId=95b71852198c, content=那最后没有好处,临床上我们就不用了吗?, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/DYAIOgq83er7lBrMCuvxicCR3XJQhu2X3SmEzicSFDknz19Vav0ln3PHYSicIKQRIiazzcibtEchpeQNrjh2jfOYC0w/132, createdBy=eb931929187, createdName=美丽明天在等我, createdTime=Wed Apr 05 00:38:08 CST 2017, time=2017-04-05, status=1, ipAttribution=)]
    2017-04-05 美丽明天在等我

    那最后没有好处,临床上我们就不用了吗?

    0

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