甲状腺激素在急性脑卒中患者中的应激变化及与预后的关系

Stress changes of thyroid hormone in patients with acute cerebral stroke and its correlation with prognosis of patients

目的探讨甲状腺激素在急性脑卒中患者中的应激变化及与预后的关系。方法66例急性脑卒中患者分为脑出血组38例,急性缺血性脑卒中(AICVD)组28例。依脑卒中严重程度分为轻、中、重型组(分别为23、35及8例);依预后不同分为基本痊愈组、显著进步组、进步组、无变化组及死亡组(分别为25、11、14、3及13例);根据是否患有低三碘甲状腺原氨酸(T3)综合征分为低T3组(39例)和正常T3组(27例);另将同期无甲状腺相关疾病的健康体检者60例纳为对照组,比较不同类型脑卒中治疗前后甲状腺激素水平变化及不同预后患者的甲状腺激素水平。结果急性期,与对照组比较,AICVD组和脑出血组T3水平均降低(P<0.05),四碘甲状腺原氨酸(T4)水平均升高(P<0.05);恢复期,AICVD组和脑出血组T3较急性期升高,T4较急性期降低(P<0.05);而各组间及组内恢复期与急性期促甲状腺激素(TSH)比较,差异均无统计学意义(P>0.05);随着病情加重,T3水平呈下降趋势,T4水平呈上升趋势(P<0.05),而TSH水平差异无统计学意义(P>0.05);随着预后变差,患者T3水平呈下降趋势,T4水平呈升高趋势(P<0.05),TSH水平差异均无统计学意义(P>0.05);入院时和出院时,低T3组神经功能缺损评分均高于正常T3组,2组出院时神经功能缺损评分均较入院时降低,低T3组△神经功能缺损≥2分的比例低于正常T3组(P<0.05);Logistic回归分析结果显示,年龄、T3、神经功能缺损评分是影响急性脑卒中患者预后的独立因素(P<0.05)。结论急性脑卒中急性期存在甲状腺激素应激变化,T3、T4水平与患者脑卒中严重程度、预后密切相关,临床中应及时患者纠正甲状腺激素水平。

Objective To investigate the stress changes of thyroid hormone in patients with acute cerebral stroke and its correlation with prognosis of patients.Methods A total of 66 patients with acute cerebral stroke were divided into intracerebral hemorrhage group(ICH group,n=38)and acute ischemic cerebral vascular disease group(AICVD group,n=28).According to different severity of stroke,these patients were divided into the mild degree group(n=23),medium degree group(n=35)and severe degree group(n=8).According to different prognosis,who were divided into basic cure group(n=25),obvious recovery group(n=11),recovery group(n=14),no-change group(n=3)and death case group(n=13).According to whether the patients had low triiodothyronine(T3)syndrome,they were divided into low T3 group(n=39)and normal T3 group(n=27).Moreover the other 60 healthy subjects who underwent physical examination in our hospital were served as control group.The changes of thyroid hormone levels before and after treatment were observed and compared among groups.Results As compared with those in control group,the triiodothyronine(T3)levels at acute stage in AICVD group and ICH group.were significantly decreased(P<0.05),however,the tetraiodothyronine(T4)levels were significantly increased(P<0.05).At convalescent period,the T3 levels in AICVD group and ICH group were significantly increased,while the T4 levels were significantly decreased,as compared with those at acute stage(P<0.05).However there were no significant differences in thyroid stimulating hormone(TSH)levels between acute stage and convalescent period among groups(P>0.05).With the aggravation of disease,the T3 levels showed a decreasing trend(P<0.05)while the T4 levels showed a increasing trend(P<0.05),but there were significant differences in TSH levels.With the prognosis being worsened,the T3 levels showed a downward trend(P<0.05)while the T4 levels showed an upward trend(P<0.05),however,there were no significant differences in TSH levels.The neurological deficit scores on admission and at discharging fom hospital in low T3 group were significantly higher than those in normal T3 group,and the scores at discharging from hospital were significantly lower than those on admission in both groups,and the proportion of patients with neurological deficit scores≥2 points was significantly lower than that in normal T3 group(P<0.05).Logistic regression analysis showed that patient’s age,T3 and neurological deficit score were independent factors influencing the prognosis of patients with acute cerebral stroke(P<0.05).Conclusion Thyroid hormone stress changes exist in the acute stage of acute cerebral stroke.The levels of T3 and T4 areclosely related to the severity and prognosis of patients with acute cerebral stroke,therefore,it is necessary to correct timely the thyroid hormone levels in clinical practice.