甲状腺激素水平、TOAST分型与急诊急性缺血性脑卒中患者短期预后的关系研究

Correlation between Thyroid Hormones Levels,TOAST Subtypes and Short-term Prognosis in Patients with Acute Ischemic Stroke in Emergency Department

背景目前,有关甲状腺激素水平对急性缺血性脑卒中(AIS)患者短期预后影响的研究报道较少。目的探讨甲状腺激素水平、TOAST分型与急诊AIS患者短期预后的关系。方法选取2017年10月—2019年9月在中国康复研究中心北京博爱医院急诊科就诊的AIS患者124例作为病例组,另选取同期中国康复研究中心北京博爱医院体检中心的体检健康者140例作为对照组。比较病例组与对照组年龄、性别及血清甲状腺激素〔包括促甲状腺激素(TSH)、三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)〕水平,急诊AIS患者短期预后影响因素分析采用单因素分析及多因素Logistic回归分析;绘制受试者工作特征(ROC)曲线以评价FT3、TSH及二者联合对急诊AIS患者短期预后的预测效能。结果病例组患者血清TSH、T3、FT3水平低于对照组,血清T4、FT4水平高于对照组(P<0.05)。AIS患者入院后14 d,预后不良64例(占51.6%)。预后不良患者年龄大于预后良好患者,入院时美国国立卫生研究院卒中量表(NIHSS)评分高于预后良好患者,血清TSH、T3、FT3水平低于预后良好患者(P<0.05);预后不良与预后良好患者TOAST分型比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,入院时NIHSS评分〔OR=2.748,95%CI(1.741,4.339)〕、血清TSH水平〔OR=0.581,95%CI(0.358,0.944)〕、血清FT3水平〔OR=0.408,95%CI(0.216,0.772)〕、大动脉粥样硬化型(LAA)〔OR=8.188,95%CI(2.441,27.466)〕、心源性栓塞型(CE)〔OR=6.523,95%CI(1.510,28.175)〕是急诊AIS患者短期预后的独立影响因素(P<0.05)。ROC曲线分析结果显示,TSH、FT3及二者联合预测急诊AIS患者短期预后的曲线下面积(AUC)分别为0.791、0.836、0.870,最佳截断值分别为1.17 mU/L、3.14 pmol/L、0.52,灵敏度分别为0.804、0.595、0.836,特异度分别为0.745、0.949、0.800。TSH联合FT3预测急诊AIS患者短期预后的AUC大于TSH(P<0.05)。结论血清TSH、FT3水平降低及TOAST分型为LAA、CE是急诊AIS患者短期预后不良的危险因素,且TSH联合FT3对急诊AIS患者短期预后的预测效能较好,故早期检测甲状腺激素水平并进行TOAST分型有助于AIS患者风险分层。

Background The present researches about the effects of thyroid hormone levels on the short-term prognosis of patients with acute ischemic stroke(AIS)have rarely been reported.Objective To investigate the correlation between thyroid hormones,TOAST subtypes and short-term prognosis in patients with AIS in Emergency Department.Methods A total of 124 AIS patients in the Emergency Department of Beijing Bo'ai Hospital,China Rehabilitation Research Center from October 2017 to September 2019 were recruited as the case group,and 140 healthy people in the Physical Examination Center of Beijing Bo'ai Hospital,China Rehabilitation Research Center during the same period were recruited as the control group.The age,sex distribution and thyroid hormone levels(including TSH,T3,T4,FT3 and FT4)in both the groups were compared.Univariate analysis and multivariate Logistic regression analysis were used to analyze the influencing factors of short-term prognosis in patients with AIS in Emergency Department.Receiver operating characteristic(ROC)curve was used to analyzed the predictive effectiveness of FT3,TSH and their combination on the short-term prognosis in patients with AIS in Emergency Department.Results The serum levels of TSH,T3 and FT3 in the case group were lower than those in the control group,while the levels of T4 and FT4 in the case group were higher than those in the control group(P<0.05).Fourteen days after admission,64 patients(51.6%)had a poor prognosis.The patients with poor prognosis were older than those with good prognosis(P<0.05).On admission,the patients with high NIHSS score had poor prognosis(P<0.05).While the serum levels of TSH,T3 and FT3 in patients with poor prognosis were lower than those in patients with good prognosis(P<0.05).The significantly differences were recorded in TOAST subtypes of the patients between the poor prognosis and good prognosis(P<0.05).Multivariate Logistic regression analysis showed that NIHSS score at admission〔OR=2.748,95%CI(1.741,4.339)〕,serum TSH level〔OR=0.581,95%CI(0.358,0.944)〕,serum FT3 level〔OR=0.408,95%CI(0.216,0.772)〕,LAA〔OR=8.188,95%CI(2.441,27.466)〕and CE〔OR=6.523,95%CI(1.510,28.175)〕were independent influencing factors for short-term prognosis in patients with AIS in Emergency Department(P<0.05).The results of ROC curves analysis showed that the area under the curves(AUCs)of TSH,FT3 and their combination in predicting short-term prognosis in patients with AIS in Emergency Department was 0.791,0.836,0.870,respectively,the best cut-off values were 1.17 mU/L,3.14 pmol/L and 0.52,the sensitivities were 0.804,0.595 and 0.800,and the specificities were 0.745,0.949 and 0.836,respectively.The AUC of TSH combined with FT3 in predicting short-term prognosis in patients with AIS in Emergency Department was greater than that of TSH(P<0.05).Conclusion The decreases of serum TSH and FT3 levels and TOAST subtypes of LAA and CE are risk factors for poor short-term prognosis in patients with AIS in Emergency Department,and TSH combined with FT3 has a good predictive effect on short-term prognosis in patients with AIS in Emergency Department.Therefore,the early detection of thyroid hormone levels and making TOAST classification are helpful for risk stratification in AIS patients.