不同甲状腺激素水平对急性脑梗死患者预后及神经功能的影响

Effects of Different Thyroid Hormone Levels on Prognosis and Nerve Function of Patients with Acute Cerebral Infarction

目的分析不同甲状腺激素水平对急性脑梗死(ACI)患者预后及神经功能恢复的影响。方法选择商洛市中心医院2014年9月—2016年10月收治的108例ACI患者(脑梗死组)和同期60例健康体检者(正常组),对比两组甲状腺激素水平;根据入院时神经功能缺损量表(NIHSS)评分将108者分为轻、中、重度3组,对比3组甲状腺激素水平;对比入院时不同三碘甲状腺原氨酸(T_3)和游离三碘甲状腺原氨酸(FT_3)水平,3个月后改良Rankin量表(mRS)评分和NIHSS评分;分析脑梗死组入院时T_3、FT_3水平与3个月后NIHSS评分和mRS评分的相关性。结果脑梗死组血清T_3、FT_3和促甲状腺激素水平均低于正常组,游离甲状腺素水平高于正常组(P<0.05,P<0.01)。脑梗死组不同程度患者T_3和FT_3水平随着病情加重而逐渐下降(P<0.01)。低T_3组和低FT_3组NIHSS评分及mRS评分分别高于高T_3组和高FT_3组(P<0.05)。脑梗死组入院时血清T_3、FT_3水平与3个月后NIHSS评分和mRS评分均呈负相关(P<0.05)。结论 ACI患者T_3和FT_3水平下降,血清T_3和FT_3水平较低提示患者预后和神经功能恢复情况较差。

Objective To analyze effects of different thyroid hormone levels on prognosis and nerve function ofpatients with acute cerebral infarction （ ACI） . Methods A total of 108 ACI patients （ cerebral infarction group）and 60healthy people taking physical examination （ normal group）during September 2014 and October 2016 were recruited inthis study,and thyroid hormone levels were compared in two groups. The cerebral infarction group was divided into mild,moderate and severe subgroups according to neurologic impairment scores （ NIHSS）at the time of admission,and thyroidhormone levels were compared in the three subgroups. Levels of triiodothyronine （ T3 ）and free triiodothyronine （ FT3 ）atthe time of admission,and modified Rankin scale （ mRS）and NIHSS scores after 3 months of treatment were compared.Correlations between T3 and FT3 levels at the time of admission with NIHSS and mRS scores after 3 months of treatmentwere analyzed in cerebral infarction group. Results Serum T3 ,FT3 and thyroid stimulating hormone levels in cerebralinfarction group were significantly lower,while free thyroxine level was significantly higher than those in normal group（ P 〈 0. 05,P 〈 0. 01） . T3 and FT3 levels in patients with different grades of cerebral infarction gradually decreased withaggravated pathogenetic condition （ P 〈 0. 01） . NIHSS and mRS scores in low T3 subgroup and tlow FT3 subgroup weresignificantly higher than those in high T3 subgroup and high FT3 subgroup respectively （ P 〈 0. 05） . Serum T3 and FT3levels at the time of admission were negatively correlated with NIHSS and mRS scores after 3 months of treatment in cerebral infarction group （ P 〈 0. 05） . Conclusion Serum T3 and FT3 levels are decreased in ACI patients with low T3 andFT levels indicate that the prognosis and recovery of neurological function are poor.