亚临床甲状腺功能亢进和急性脑梗死早期神经功能恶化的相关性研究

The association between subclinical hyperthyroidism and early neurological deterioration in patients with acute cerebral infarction

目的探讨亚临床甲状腺功能亢进对急性脑梗死早期神经功能恶化的影响。方法连续纳人2015年3月至2016年9月于浙江医院神经内科住院，且起病到人院时间间隔〈3d的急性缺血性脑卒中患者。早期神经功能恶化（END）定义为人院7d内任意1次美国国立卫生研究院卒中量表评分（NIHSS）较入院基线NIHSS评分增加≥2分。采用化学发光法测定甲状腺功能，并将亚临床甲状腺功能亢进定义为促甲状腺激素（TSH）：0．10-0．44mU／L，而甲状腺功能正常。运用单因素分析比较组间差异，同时进行多变量Logistic回归分析亚临床甲状腺功能亢进与END的相关性。结果共纳入符合入组和排除标准的患者139例，其中END组42例（30．2％），非END组97例（69．8％）。与非END组相比，END组患者年龄[（71．2±5．7）岁比（68．1±6．3）岁，t=2．695，P=0．008）3、亚临床甲状腺功能亢进比率（28．6％比9．3％，χ2=8．506，P=0．006）、C反应蛋白[5．6（1．0，11．0）mg／L比2．5（1．0，5．O）mg／L，Z=2．125，P=0．0343、同型半胱氨酸[（15．3±5．8）mmol／L比（13．0±4．8）mmol／L，t=2．395，P=0．018）]及空腹血糖水平[（8．1±2．2）mmol／L比（6．3±2．6）mmol／L，t=4．108，P=0．001）]均明显升高。多因素Logistic回归分析结果显示，经过校正年龄、c反应蛋白、同型半胱氨酸及空腹血糖水平等混杂因素后，亚临床甲状腺功能亢进（OR：3．415，95％CI：1．14810．161，P=0．027）是END的独立危险因素。结论亚临床甲状腺功能亢进与急性脑梗死患者END显著相关。

Objective To detect the association between subclinical hyperthyroidism and early neurological deterioration （END） in patients with acute cerebral infarction. Methods Totally 139 patients diagnosed with acute ischemic stroke were prospectively enrolled between March 2015 and September 2016. The early neurological deterioration was defined as 7-day in-hospital increase （vs. that at admission） in the NIHSS score of ≥2 points without any systemic cause. Muhivariable Logistic regression analysis was conducted to evaluate the relationship between subclinical hyperthyroidism and END. Subclinical hyperthyroidism is defined as TSH 〈0.44 mU/L, with normal FT3 and FT4. Muhivariable Logistic regression analysis was conducted to evaluate the relationship between subclinical hyperthyroidism and END. Results 42 （30.2%） patients with END among 139 with subclinical hyperthyroidism were observed. As compared with patients without END, patients with END showed older age[（71.2 ± 5.7） years vs. （68.1 ± 6.3） years, t = 2. 695, P = 0. 0083, higher prevalence of subclinical hyperthyroidism （28.6 ~ vs. 9.3 ~, Z2 = 8. 506, P = 0. 006）, and higher levels of C-reactive protein （5.6 （ 1.0, 11.0） mg/L vs. 9.. 5 （ 1.0, 5.0） mg/L, Z = 2. 125, P = 0. 0343, homocysteine〈（15. 3±5. 8） mmol/L vs. （13.0±4.8） mmol/L,t=2. 395 ,P=0. 0183and fasting blood-glucose（（8.1 ± 2.2） mmol/L vs. （6.3 ± 2.6） mmol/L, t = 4. 108, P = 0. 001]. Logistic regression analysis indicated that subclinical hyperthyroidism was associated with END after adjustment for potential confounders （ OR = 3. 415,95 % CI： 1. 148-10.167, P = 0. 027 ）. Conclusions Subclinical hyperthyroidism is a significant and independent predictor for END in patients with acute cerebral infarction.