急性脑血管病甲状腺功能改变与NIHSS和年龄的相关性

Study on the Correlation of Changes of Thyroid Function in Acute Cerebrovascular Disease with NIHSS and Age

目的探讨甲状腺功能的改变与急性脑血管病的轻重和预后转归的关系,及与年龄和美国国立卫生研究院卒中量表评分(NIHSS)的相关性。方法选择2010年10月至2012年3月广西医科大学第一附属医院神经内科收治住院的脑血管病急性期(发病72 h内)患者72例作为脑血管病组,选择同期收治的没有脑血管病及其他影响甲状腺功能的疾病的就诊者30例作为对照组。对两组进行NIHSS评分,检测甲状腺激素,对三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺释放素(TSH)、NIHSS进行比较及相关性分析。结果脑血管病组NIHSS显著高于对照组[(11.38±3.47)比(0.00±0.00),P<0.05]、T3和FT3显著低于对照组[T3:(1.20±0.36)nmol/L比(1.48±0.27)nmol/L、FT3:(3.60±0.92)pmol/L比(4.23±0.51)pmol/L,P<0.05]。2对照组、NIHSS中分组、NIHSS高分组两两比较,T3比较差异有统计学意义,分别为(1.48±0.27)、(1.32±0.32)、(0.99±0.35)nmol/L;NIHSS中分组、NIHSS高分组FT3显著低于对照组[(3.68±0.97),(3.46±0.82)pmol/L比(4.23±0.51)pmol/L,P<0.05]。3T3与NIHSS、年龄呈负相关,T4、FT3与NIHSS评分呈负相关,FT4和TSH与NIHSS、发病年龄无明显相关性。结论急性脑血管病影响甲状腺激素异常改变,以T3、FT3下降为主。对于急性脑血管病NIHSS评分越高,T3及FT3下降越明显。年龄越大,T3下降明显。严重低T3和T4的患者对病情严重程度有提示作用。

Objective To investigate the correlation of changes of thyroid function with the severity and prognosis of patients with acute cerebrovascular disease,as well as with U.S.National Institutes of Health Stroke Scale（ NIHSS） and ages of the patients.Methods A total of 72 patients with acute cerebrovascular disease（onset within 72 h） admitted in Department of Neurology,the First Affiliated Hospital of Guangxi Medical University from Oct.2010 to Mar.2012 were selected as the cerebrovascular disease group, and another 30 patients that had no cerebrovascular disease or other diseases affecting thyroid function admitted in the hospital during the same period were selected as the control group .NIHSS scores of the two groups were evaluated and compared,levels of thyroid hormones,including triiodothyronine（T3）,thyroxine（T4）,free trii-odothyronine （ FT3 ） , free thyroxine （ FT4 ） , thyrotropin （ TSH ） of the two groups were detected and com-pared.Correlationbetweensuchthyroidhormonesand NIHSS was analyzed.Results ①NIHSSscoreofthe cerebrovascular disease group was significantly higher than the control group [（11.38 ±3.47） vs （0.00 ± 0.00）,P〈0.05],levels of T3 and FT3 of the cerebrovascular disease group were significantly lower than the control group [T3：（1.20 ±0.36） nmol/L vs （1.48 ±0.27） nmol/L,FT3：（3.60 ±0.92） pmol/L vs （4.23 ±0.51） pmol/L,P〈0.05].②Levels of T3 in the control group,medium NIHSS score group,high NIHSS score group were respectively （1.48 ±0.27） nmol/L,（1.32 ±0.32） nmol/L and （0.99 ± 0.35） nmol/L, the differences between either two groups were statistically significant;level of FT3 in the medium NIHSS score group and high NIHSS score group the control group were significantly higher than [（3.68 ±0.97） pmol/L,（3.46 ±0.82） pmol/L vs （4.23 ±0.51） pmol/L,P〈0.05].③T3 had nega-tive correlation with NIHSS and age,but T4 and FT3 had inferior correlation with NIHSS,and FT4 ,TSH had no obvious correlation with NIHSS and age.Conclusion Acute cerebrovascular disease has impact on the thyroid hormone abnormalities,which mainly presented with the decrease of T3 and FT3 levels.The higher NIHSS scores of acute cerebrovascular disease,the more significantly T3 and FT3 levels decline.The older the patients are,the more significantly T3 level decreases.Severely low levels of T3 and T4 in patients indicate the severity of the disease.