甲状腺抗体水平与急性缺血性卒中患者颈动脉粥样硬化斑块的相关性

Correlation between thyroid antibody level and carotid atherosclerotic plaque in patients with acute ischemic stroke

目的探讨血清甲状腺抗体水平与急性缺血性卒中患者颈动脉粥样硬化斑块的相关性。方法回顾性纳入连续的急性缺血性卒中患者。根据颈部动脉彩超结果分为无斑块组和斑块组，斑块组再分为稳定斑块组和不稳定斑块组。应用化学发光法测定各组血清抗甲状腺过氧化物酶抗体（thyroidperoxidase antibody, TPOAb）和抗甲状腺球蛋白抗体（thyroglobulin antibody, TGAb）水平并进行比较。结果共纳入383例急性缺血性卒中患者，116例（30.3%）无斑块，267例（69.7%）存在斑块，其中68例为稳定斑块，199例为不稳定斑块。斑块组血清TGAb水平显著高于无斑块组（Z＝－4.826，P〈0.001）。多变量logistic回归分析显示，TGAb水平可能是颈动脉斑块的独立危险因素（优势比1.007，95%可信区间1.001～1.012；P＝0.016）。稳定斑块组血清TPOAb水平显著高于不稳定斑块组（Z＝－2.114，P＝0.035），但多变量logistic回归分析显示其并非不稳定斑块的独立危险因素（优势比1.001，95%可信区间0.996～1.006；P＝0.786）。结论急性缺血性卒中患者血清甲状腺抗体升高，尤其是TGAb水平升高可能与颈动脉粥样硬化斑块的发生和发展相关，但与斑块稳定性无关。

Objective To investigate the correlation between thyroid ant^ody level and carotid atherosclerotic plaque in patients with acute ischemic stroke. Methods Consecutive patients with acute ischemic stroke were enrolled retrospectively. They were divided into a non-plaque group and a plaque group according to the findings of carotid artery color-Doppler ultrasonography. The plaque group was redivided into a stable plaque subgroup and a non-stable plaque subgroup. Chemiluminescence method was used to measure the serum thyroperoxidase antibodies （TPOAb） and thyroglobulin antibodies （TGAb） levels and they were compared. Results A total of 383 patients were enrolled in the study, including 116 （30.3%） did not have plaque and 267 （69.7%） had plaque, 68 of them had unstable plaque, and 199 had stable plaque. The level of TGAb in the plaque group was significantly higher than that in the non-plaque group （Z = - 4. 826, P 〈0. 001 ）. Multivariate logistic regression analysis showed that the level of TGAb might be an independent risk factors for carotid plaque （odds ratio 1. 007, 95% confidence interval 1. 001-1. 012; P =0. 016）. The serum level of TPOAb in the stable plaque group was significantly higher than that in the unstable plaque group （Z= -2. 114, P= 0. 035）, but multivariate logistic regression analysis showed that it was not the independent risk factor for unstable plaque （odds ratio 1. 001, 95% confidence interval 0. 996-1. 006; P = 0. 786）. Conclusions The level of serum thyroid antibodies increased in patients with acute ischemic stroke, especially the increased level of TGAb might be associated with the occurrence and development of carotid atherosclerotic plaque, however, it was not associated with the plaque stability.