单侧颈内动脉狭窄患者血清游离三碘甲状腺原氨酸、游离甲状腺素水平变化及其与脑血流灌注、认知功能的相关性研究

Changes of Serum Levels of FT3 and FT4 and Their Correlations with Cerebral Blood Flow Perfusion and Cognitive Function in Patients with Unilateral Internal Carotid Stenosis

背景部分颈内动脉狭窄患者无明显临床症状,易被忽视,而颈内动脉狭窄严重时可导致认知障碍,但目前临床尚无诊断颈内动脉狭窄的特异性指标,相关生物学标志物可能对该病的诊疗具有重要价值。目的分析单侧颈内动脉狭窄患者血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平变化及其与脑血流灌注、认知功能的相关性。方法选取2017年1月-2018年7月沧州市中心医院收治的单侧颈内动脉狭窄患者100例作为研究组,其中轻度狭窄(狭窄率<30%)24例,中度狭窄(30%≤狭窄率<70%)59例,重度狭窄(狭窄率≥70%)19例;另选取同期门诊体检者100例作为对照组。比较对照组与研究组受试者一般资料及实验室检查指标,并比较不同颈内动脉狭窄程度患者血清促甲状腺激素(TSH)、FT3、FT4水平及脑血流灌注指标〔包括相对平均脑血流量(rCBF)、相对平均脑血容量(rCBV)、相对平均通过时间(rMTT)、相对平均达峰时间(rTTP)〕、蒙特利尔认知评估量表(MoCA)评分;血清FT3、FT4水平与单侧颈内动脉狭窄患者rMTT、rTTP及MoCA评分的相关性分析采用Pearson相关分析。结果(1)对照组与研究组受试者性别、年龄、吸烟率、高血压发生率比较,差异无统计学意义(P>0.05);研究组患者体质指数(BMI)及血清TSH、三酰甘油(TG)、总胆固醇(TC)、糖化血红蛋白(HbA1c)水平高于对照组,血清FT3、FT4水平低于对照组(P<0.05)。(2)不同颈内动脉狭窄程度患者血清TSH水平比较,差异无统计学意义(P>0.05);重度颈内动脉狭窄患者血清FT3、FT4水平低于轻、中度颈内动脉狭窄者(P<0.05)。(3)不同颈内动脉狭窄程度患者rCBF、rCBV比较,差异无统计学意义(P>0.05)。中、重度颈内动脉狭窄患者rMTT、rTTP长于轻度颈内动脉狭窄者,MoCA评分低于轻度颈内动脉狭窄者(P<0.05);重度颈内动脉狭窄患者rMTT、rTTP长于中度颈内动脉狭窄者,MoCA评分低于中度颈内动脉狭窄者(P<0.05)。(4)Pearson相关分析结果显示,血清FT3水平与单侧颈内动脉狭窄患者rMTT(r=-0.402)、rTTP(r=-0.443)呈负相关(P<0.05),血清FT4水平与单侧颈内动脉狭窄患者rMTT(r=-0.410)、rTTP(r=-0.453)亦呈负相关(P<0.05);血清FT3(r=0.406)、FT4水平(r=0.403)与单侧颈内动脉狭窄患者MoCA评分均呈正相关(P<0.05)。结论单侧颈内动脉狭窄患者血清FT3、FT4水平较低,且颈内动脉狭窄程度越重则血清FT3、FT4水平越低;血清FT3、FT4水平与单侧颈内动脉狭窄患者rMTT、rTTP呈负相关,与MoCA评分呈正相关。

Background Some patients with internal carotid stenosis are easy to be ignored due to lack of obvious clinical symptoms,but it may even lead to cognitive dysfunction,however,there is no specific diagnostic index of internal carotid stenosis on clinic at present,some relevant biological makers may have significant value in the diagnosis and treatment.Objective To analyze the changes of serum levels of FT3 and FT4 and their correlations with cerebral blood flow perfusion and cognitive function in patients with unilateral internal carotid stenosis.Methods A total of 100 patients with unilateral internal carotid stenosis were selected as research group in Cangzhou Central Hospital from January 2017 to July 2018,including 24 cases with mild stenosis(with stenosis rate<30%),59 cases with moderate stenosis(with stenosis rate equal to or over 30%but less than 70%)and 19 cases with severe stenosis(with stenosis rate≥70%);meanwhile 100 outpatients admitted to this hospital for physical examination were selected as control group.General information and laboratory examination results were compared between control group and research group,serum levels of TSH,FT3 and FT4,indicators of cerebral blood flow perfusion〔including relative mean cerebral blood flow(rCBF),relative mean cerebral blood volume(rCBV),relative mean transit time(rMTT),relative mean time to peak(rTTP)〕and MoCA score were compared in patients with different degrees of internal carotid stenosis;Pearson correlation analysis was used to analyze the correlations of serum levels of FT3 and FT4 with rMTT,rTTP and MoCA score in patients with unilateral internal carotid stenosis.Results(1)There was no statistically significant difference in gender,age,smoking rate or incidence of hypertension between control group and research group(P>0.05);BMI,serum levels of TSH,TG,TC and HbA1c in research group were statistically significantly higher than those in control group,while serum levels of FT3 and FT4 in research group were statistically significantly lower than those in control group(P<0.05).(2)There was no statistically significant difference in serum TSH level in patients with different degrees of internal carotid stenosis(P>0.05),while serum levels of FT3 and FT4 statistically significantly decreased in patients with severe internal carotid stenosis compared with those in patients with mild to moderate internal carotid stenosis(P<0.05).(3)There was no statistically significant difference in rCBF or rCBV in patients with different degrees of internal carotid stenosis(P>0.05).Compared with those in patients with mild internal carotid stenosis,rMTT and rTTP statistically significantly prolonged but MoCA score statistically significantly decreased in patients with moderate to severe internal carotid stenosis(P<0.05);compared with those in patients with moderate stenosis,rMTT and rTTP statistically significantly prolonged but MoCA score statistically significantly decreased in patients with severe internal carotid stenosis(P<0.05).(4)Pearson correlation analysis results showed that,serum FT3 level was negatively with correlated rMTT(r=-0.402)and rTTP(r=-0.443)in patients with unilateral carotid stenosis,respectively,as well as serum FT4 level with rMTT(r=-0.410)and rTTP(r=-0.453),respectively(P<0.05);serum levels of FT3(r=0.406)and FT4(r=0.403)was positively correlated with MoCA score in patients with unilateral carotid stenosis,respectively(P<0.05).Conclusion Serum levels of FT3 and FT4 significantly decrease in patients with unilateral internal carotid stenosis,and both of them decreases as the exacerbation of degree of internal carotid stenosis,moreover they are negatively correlated with rMTT and rTTP but positively correlated with MoCA score.