94例2型糖尿病患者急性脑梗死后认知障碍与甲状腺功能的关联性

Association between cognitive impairment and thyroid function after acute ischemic stroke in 94 patients with type 2 diabetes mellitus

目的探讨2型糖尿病(T2DM)患者发生急性脑梗死后认知障碍与甲状腺相关激素水平之间的关系。方法随机选取T2DM合并急性脑梗死患者94例,根据蒙特利尔认知评估(MoCA)量表评分分为认知障碍组(n=54例)和认知正常组(n=40例)。比较认知障碍组与认知正常组血清甲状腺相关激素、生化指标水平及一般资料的差异,并进一步行多因素二元Logistic回归分析T2DM患者急性脑梗死后认知障碍的独立危险因素。结果单因素分析显示,认知障碍组促甲状腺素(TSH)水平高于认知正常组[(2.17±1.12)vs(1.29±0.71)μIU/mL,t=-4.618,P<0.001],认知障碍组游离三碘甲状腺原氨酸(FT3)水平却低于认知正常组[(3.80±0.70)vs(4.62±0.79)pmol/L,t=5.290,P<0.001]。认知障碍组既往脑梗死比例、糖化血红蛋白水平高于认知正常组(P<0.05)。两组性别比例、年龄、受教育水平、生活习惯(吸烟、饮酒)、基础疾病(高血压、冠状动脉粥样硬化性心脏病)比例、体质量指数、收缩压、舒张压、梗死灶数量、梗死部位、空腹血糖、血脂及游离甲状腺素(FT4)差异无统计学意义(P>0.05)。在调整年龄、性别、受教育水平、既往脑梗死病史、基础疾病、生活习惯、空腹血糖以及血脂等因素后,多因素二元Logistic回归分析显示,TSH可能是认知障碍的独立危险因素(OR=8.159,95%CI=2.128~31.277),而FT3可能是其保护因素(OR=0.033,95%CI=0.005~0.234)。结论 TSH可能是T2DM患者急性脑梗死后认知障碍的独立危险因素,而FT3可能是T2DM患者急性脑梗死后认知障碍的保护因素。

Objective To investigate the relationship between cognitive impairment and thyroid-related hormones after acute ischemic stroke in patients with type 2 diabetes mellitus(T2 DM). Methods A total of 94 T2 DM complicated with acute ischemic stroke were randomly selected as research objects, and were divided into the cognitive impairment group(n=54) and cognitive normal group(n=40) according to Montreal Cognitive Assessment(MoCA) scales. The differences of thyroid-related hormones, biochemical indicators and general information were compared between the two groups, and the independent risk factors of cognitive impairment after acute ischemic stroke were analyzed with multivariate binary Logistic regression analysis. Results Univariate analysis showed that the cognitive impairment group had higher level of thyroxine stimulating hormone(TSH) [(2.17±1.12) vs(1.29±0.71)μIU/mL, t=-4.618, P<0.001], lower level of free triiodothyronine(FT3) [(3.80±0.70) vs(4.62±0.79)pmol/L, t=5.290, P<0.001], higher incidence of cerebral infarction and higher level of glycosylated hemoglobin than the cognitive normal group(P<0.05). There were no statistical differences in sex, age, education level, living habits(smoking, drinking), basic diseases(hypertension, coronary heart disease), body mass index, systolic blood pressure, diastolic blood pressure, number of cerebral infarction foci, location of infarction, fasting plasma glucose, blood lipids and free thyroxine(FT4) between the two groups(P>0.05). After age, sex, education level, previous acute ischemic stroke history, basic diseases, living habits, fasting plasma glucose and blood lipids were adjusted, multivariate binary Logistic regression analysis showed that TSH(OR=8.159, 95%CI=2.128-31.277) might be an independent risk factor of cognitive impairment, while FT3(OR=0.033, 95%CI=0.005-0.234) might be a protective factor. Conclusion Elevated TSH may be an independent risk factor of cognitive impairment after acute ischemic stroke in T2 DM patients, while FT3 may be a protective factor.