急性缺血性卒中患者血清甲状腺激素表达变化对神经功能预后的预测价值
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摘要
目的探讨急性缺血性卒中患者血清甲状腺激素水平变化与病情严重程度和短期预后的相关性。方法根据血清总三碘甲状腺原氨酸(TT3)水平将98例既往无甲状腺疾病史的急性缺血性卒中患者分为低TT3组和正常TT3组,检测血清甲状腺激素水平和神经功能缺损程度,评价发病90 d时神经功能恢复情况。结果低TT3组患者神经功能缺损程度比正常TT3组严重(χ2=58.134,P=0.000),血清总甲状腺素(t=1.636,P=0.105)和促甲状腺激素(t=1.059,P=0.292)水平基本相同;血清TT3水平与神经功能缺损程度[美国国立卫生研究院卒中量表(NIHSS)]呈负相关关系(r=-0.672,P=0.000);发病90 d时低TT3组患者神经功能改善程度[NIHSS评分改善(χ2=8.993,P=0.003)和改良Rankin量表评分(χ2=6.247,P=0.012)]低于正常TT3组。结论血清低T3水平与急性缺血性卒中严重程度和神经功能改善程度存在关联性,提示血清低T3水平可能是预测急性缺血性卒中神经功能预后的一项指标。
Objective To explore the correlation between thyroid hormone levels in patients withacute ischemic stroke and the severity of disease and short- term prognosis.Methods According to thelevel of serum total triiodothyronine(TT3), 98 patients who presented first acute ischemic stroke and withouthistory of thyroid abnormality were divided into low TT3 group and normal TT3 group. Thyroid hormonelevels and neurological function defect of those patients were tested, and their neural functional recoveryafter 3 months was evaluated.Results Low TT3 group had more severe neural function defect compared tonormal TT3group(χ2= 58.134, P = 0.000). There were no significant differences on total thyroxine(TT4; t =1.636, P = 0.105) and thyroid stimulating hormone(TSH; t = 1.059, P = 0.292) between 2 groups. There wasa significantly negative correlation between TT3 levels and National Insititute of Health Stroke Scale(NIHSS) score on admission(r =- 0.672, P = 0.000). Patients with low TT3 showed a significantly smallerpercentage of neurological function improvement on both NIHSS(χ2= 8.993, P = 0.003) and modified Rankin Scale(m RS; χ2= 6.247, P = 0.012) scores compared to those with normal TT3 at 90 d after onset.Conclusions Low T3 level is associated with the severity of acute ischemic stroke and neural functionalrecovery, suggesting serum T3 level may be a predictor of neural function improvement in patients withacute ischemic stroke.
Objective To explore the correlation between thyroid hormone levels in patients withacute ischemic stroke and the severity of disease and short- term prognosis.Methods According to thelevel of serum total triiodothyronine(TT3), 98 patients who presented first acute ischemic stroke and withouthistory of thyroid abnormality were divided into low TT3 group and normal TT3 group. Thyroid hormonelevels and neurological function defect of those patients were tested, and their neural functional recoveryafter 3 months was evaluated.Results Low TT3 group had more severe neural function defect compared tonormal TT3group(χ2= 58.134, P = 0.000). There were no significant differences on total thyroxine(TT4; t =1.636, P = 0.105) and thyroid stimulating hormone(TSH; t = 1.059, P = 0.292) between 2 groups. There wasa significantly negative correlation between TT3 levels and National Insititute of Health Stroke Scale(NIHSS) score on admission(r =- 0.672, P = 0.000). Patients with low TT3 showed a significantly smallerpercentage of neurological function improvement on both NIHSS(χ2= 8.993, P = 0.003) and modified Rankin Scale(m RS; χ2= 6.247, P = 0.012) scores compared to those with normal TT3 at 90 d after onset.Conclusions Low T3 level is associated with the severity of acute ischemic stroke and neural functionalrecovery, suggesting serum T3 level may be a predictor of neural function improvement in patients withacute ischemic stroke.
引文
[1]Nanchen D,Gussekloo J,Westendorp RG,Stott DJ,Jukema JW,Trompet S,Ford I,Welsh P,Sattar N,Macfarlane PW,Mooijaart SP,Rodondi N,de Craen AJ;PROSPER Group.Subclinical thyroid dysfunction and the risk of heart failure in older persons at high cardiovascular risk.J Clin Endocrinol Metab,2012,97:852-861.
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[7]Baek JH,Chung PW,Kim YB,Moon HS,Suh BC,Jin DK,Kim BM,Rhee EJ,Lee YT,Park KY.Favorable influence of subclinical hypothyroidism on the functional outcomes in stroke patients.Endocr J,2010,57:23-29.
[8]Mdzinarishvili A,Sutariya V,Talasila PK,Geldenhuys WJ,Sadana P.Engineering triiodothyronine(T3)nanoparticle for use in ischemic brain stroke.Drug Deliv Transl Res,2013,3:309-317.
[2]Wang WY,Tang YD,Yang M,Cui C,Mu M,Qian J,Yang YJ.Free triiodothyronine level indicates the degree of myocardial injury in patients with acute ST-elevation myocardial infarction.Chin Med J(Engl),2013,126:3926-3929.
[3]Waring AC,Harrison S,Samuels MH,Ensrud KE,LeBLanc ES,Hoffman AR,Orwoll E,Fink HA,Barrett-Connor E,Bauer DC;Osteoporotic Fractures in Men(MrOS)Study.Thyroid function and mortality in older men:a prospective study.J Clin Endocrinol Metab,2012,97:862-870.
[4]Adams HP Jr,Leclerc JR,Bluhmki E,Clarke W,Hansen MD,Hacke W.Measuring outcomes as a function of baseline severity of ischemic stroke.Cerebrovasc Dis,2004,18:124-129.
[5]Farwell AP.Nonthyroidal illness syndrome.Curr Opin Endocrinol Diabetes Obes,2013,20:478-484.
[6]Alevizaki M,Synetou M,Xynos K,Pappa T,Vemmos KN.Low triiodothyronine:a strong predictor of outcome in acute stroke patients.Eur J Clin Invest,2007,37:651-657.
[7]Baek JH,Chung PW,Kim YB,Moon HS,Suh BC,Jin DK,Kim BM,Rhee EJ,Lee YT,Park KY.Favorable influence of subclinical hypothyroidism on the functional outcomes in stroke patients.Endocr J,2010,57:23-29.
[8]Mdzinarishvili A,Sutariya V,Talasila PK,Geldenhuys WJ,Sadana P.Engineering triiodothyronine(T3)nanoparticle for use in ischemic brain stroke.Drug Deliv Transl Res,2013,3:309-317.