合并低三碘甲状腺原氨酸综合征对急性脑梗死患者预后及认知功能的影响

Effect of Low T_3 Syndrome on Prognosis and Cognitive Function of Patients with Acute Cerebral Infarction

目的探讨低三碘甲状腺原氨酸(T3)综合征对急性脑梗死(ACI)患者预后及认知功能的影响。方法选取2010年9月—2012年12月入住浙江医院神经内科的首次ACI患者87例,发病时间在24 h内。检测患者血清甲状腺激素水平,根据T3水平,将患者分为低T3组和正常T3组。同时在患者入院时进行美国国立卫生研究院卒中量表(NIHSS)评定,随访30 d时采用改良Rankin量表(mRS)和简易智力状态检查量表(MMSE)分别进行卒中后躯体功能及认知功能评定。结果 87例ACI患者中,低T3组26例(29.9%),正常T3组61例(70.1%);前者入院时NIHSS评分高于后者〔(12.3±5.6)分与(6.2±5.5)分,P<0.05〕,疾病严重程度(轻、中、重度分别为3、17、6例)重于后者(轻、中、重度分别为36、20、5例,P<0.05)。随访30 d后,低T3组mRS评分高于正常T3组〔(3.8±1.3)分与(2.1±1.6)分,P<0.05〕,MMSE评分低于正常T3组〔(24.2±3.3)分与(26.1±3.4)分,P<0.05〕,预后不良、认知功能障碍发生率〔92.3%(24/26)和58.3%(14/24)〕均高于正常T3组〔42.6%(26/61)和32.8%(20/61),P<0.05〕。多因素Logistic回归分析显示,NIHSS评分、T3水平与ACI患者的预后存在回归关系(P<0.05);年龄、NIHSS评分、T3水平与ACI患者的认知功能存在回归关系(P<0.05)。结论 ACI患者急性期存在较大比例的低T3综合征,T3水平降低是患者预后不良及认知功能障碍的危险因素。

Objective To investigate the effect of low T3 syndrome on prognosis and cognitive function of patients with acute cerebral infarction（ACI）.Methods A total of 87 first ACI patients who were treated in department of neurology,Zhejiang Hospital,from september 2010 to December 2012,were selected as study subjects,the time between the onset time and study time were no more than 24 hours.The patients were divided into low T3 group and normal T3 group according to serum T3 levels of patients.Patients were evaluated by NIHSS scale on admission,30 days later,prognosis and cognitive function were evaluated by modified Rankin′s scale（mRS） and MMSE respectively.Results Among 87 ACI patients,there were twenty-six patients（29.9%） in low T3 group,there were 61 patients （70.1%） in normal T3 group.NIHSS score of low T3 group was significantly higher than that of normal T3 group on admission[（12.3±5.6） vs.（6.2±5.5）,P〈0.05],and the disease severity of low T3 group（3 cases in mild grade,17 cases in moderate grade,6 cases in severe grade） was significantly higher than that of normal T3 group（36 cases in mild grade,20 cases in moderate grade,5 cases in severe grade,P〈0.05）.30 days later,mRS score of low T3 group was significantly higher than that of normal T3 group[（3.8±1.3） vs.（2.1±1.6）,P〈0.05],MMSE score of low T3 group was significantly lower than that of normal T3 group[（24.2±3.3）vs.（26.1±3.4）,P〈0.05].Also,the prevalence of poor outcome（mRS〉2） and cognitive dysfunction（MMSE〈24） in low T3 group were significantly higher than those in normal T3 group[92.3%（24/26） vs.42.6%（26/61）,58.3%（14/24） vs.32.8%（20/61）,P〈0.05].Multiple Logistic regression analyses revealed that NIHSS score and T3 concentration were associated with the prognosis of ACI patients（P〈0.05）;Age,T3 concentration,and NIHSS score were associated with the cognitive function of ACI patients（P〈0.05）.Conclusion The prevalence of low T3 syndrome among ACI patients was high during the acute phase,low T3 level was the risk factor for poor outcome and cognitive dysfunction.