血清促甲状腺素水平与急性缺血性卒中患者转归的相关性

Associations between serum thyroid-stimulating hormone levels and outcomes in patients with acute ischemic stroke

目的探讨血清促甲状腺素（thyroid-stimulating hormone, TSH）水平与急性缺血性卒中转归的相关性。方法前瞻性纳入急性缺血性卒中患者，收集一般临床资料、血管危险因素和甲状腺激素等生化指标。应用美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale, NIHSS）评估基线神经功能缺损程度。在发病后90 d时采用改良Rankin量表（modified Rankin Scale, mRS）评估神经功能转归，0～2分定义为转归良好。采用多变量logistic回归分析确定急性缺血性卒中患者转归不良的独立影响因素。结果共纳入140例急性缺血性卒中患者，其中男性95例（67.86%），女性45例（32.14%），年龄35～94岁。亚临床甲状腺功能减退13例（9.29%），亚临床甲状腺功能亢进17例（12.14%）。98例（70.00%）转归良好，42例（30.00%）转归不良。转归良好组男性（χ2＝4.717，P＝0.047）和小动脉闭塞性卒中（χ2＝5.564，P＝0.018）患者构成比以及尿酸（t＝2.602，P＝0.010）、FT3（t＝2.406，P＝0.017）和TSH（t＝2.302，P＝0.023）水平显著高于转归不良组，年龄（t＝－3.489，P＝0.001）、空腹血糖（Z＝－2.178，P＝0.031）和基线NIHSS评分（t＝－8.009，P〈0.001）显著低于转归不良组。转归良好组TSH位于第1四分位数（〈0.805 mU/L）的患者构成比显著低于转归不良组（17.35%对42.86%；χ2＝10.204，P＝0.003），而位于第4四分位数（〉2.476 mU/L）的患者构成比显著高于转归不良组（30.61%对11.90%；χ2＝5.488，P＝0.020）。多变量logistic回归分析显示，在校正各种混杂因素后，基线NIHSS评分较高是发病后90 d时转归不良的独立危险因素（优势比1.690，95%可信区间1.317～2.168；P〈0.001），而基线TSH水平较高与转归良好独立相关（优势比0.520，95%可信区间0.408～0.867；P＝0.007）。结论血清TSH水平较高与急性缺血性卒中患者发病后90 d时神经功能转归良好独立相关。

ObjectiveTo investigate the correlation between the serum thyroid-stimulating hormone levels and the outcomes in patients with acute ischemic stroke.MethodsPatients with acute ischemic stroke were enrolled prospectively. The general clinical data, vascular risk factors, and biochemical indexes including thyroid hormones were collected. The National Institutes of Health Stroke Scale （NIHSS） was used to evaluate the severity of baseline neurologic deficit. The modified Rankin Scale （mRS） was used to evaluate the neurological outcomes at day 90 after onset. The mRS 0-2 was defined as good outcome. Multivariate logistic regression analysis was used to identify the independent influencing factors of the poor outcomes in patients with acute ischemic stroke.ResultsA total of 140 patients with acute ischemic stroke were enrolled, including 95 men （67.86%） and 45 women （32.14%）, aged 35-94 years old. Thirteen patients （9.29%） had subclinical hyperthyroidism and 17 （12.14%） had subclinical hypothyroidism. Ninety-eight patients （70.00%） had good outcome and 42 （30.00%） had poor outcome. The proportions of male （χ2=4.717, P=0.047） and small arterial occlusive stroke （χ2=5.564, P=0.018）, as well as uric acid （t=2.602, P=0.010）, FT3 （t=2.406, P=0.017）, and TSH （t=2.302, P=0.023） in the good outcome group were significantly higher than those in the poor group （P=0.001）; age （t=-3.489, P=0.001）, fasting blood glucose （Z= -2.178, P=0.031）, and baseline NIHSS score （t=-8.009, P〈0.001） were significantly lower than those of poor outcome group. The proportion of patients with TSH in the first quartile （〈0.805 mU/L） in the good outcome group was significantly lower than that in the poor outcome group （17.35% vs. 42.86%; χ2=10.204, P=0.003, and that in the fourth quartile （〉2.476 mU/L） was significantly higher than the poor outcome group （30.61% vs. 11.90%; χ2=5.488, P=0.002）. Multivariate logistic regression analysis showed that after adjusting various confounding factors, the higher baseline NIHSS score was an independent risk factor for poor outcome at day 90 after onset （odds ratio, 1.690, 95% confidence interval 1.317-2.168; P〈0.001）, while the higher baseline TSH level was associated with good outcome （odds ratio, 0.520, 95% confidence interval 0.408-0.867; P=0.007）.ConclusionsThe higher serum TSH level was independently associated with good neurological outcome at day 90 after onset in patients with acute ischemic stroke.