老年人甲状腺激素和甲状腺自身抗体水平与急性缺血性脑卒中发病和病情程度的关系

Relationship of thyroid hormone and thyroid autoantibody levels with incidence and severity of acute ischemic stroke in elderly people

目的探讨老年人甲状腺激素及甲状腺自身抗体水平与急性缺血性脑卒中发病和病情程度的关系。方法选择200例老年急性缺血性脑卒中患者作为脑卒中组,另选择200例同期老年健康体检者作为对照组,并根据美国国立卫生院研究卒中量表评分标准,将脑卒中组分为轻型亚组、中型亚组、重型亚组。比较两组的一般资料、血脂水平、血清甲状腺激素[游离三碘甲状腺原氨酸(FT_(3))、游离四碘甲状腺原氨酸(FT 4)、促甲状腺激素(TSH)]水平、甲状腺自身抗体[甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TgAb)]水平。采用Logistic回归模型分析老年人发生急性缺血性脑卒中的影响因素。比较不同病情程度急性缺血性脑卒中患者的甲状腺激素和甲状腺自身抗体水平。结果与对照组比较,脑卒中组心房颤动史比例以及TPOAb、TgAb、三酰甘油、TSH水平升高,FT_(3)水平降低(均P<0.05)。多因素Logistic回归分析结果显示,TPOAb水平升高、心房颤动是老年人发生急性缺血性脑卒中的独立危险因素,FT_(3)水平升高是保护因素(均P<0.05)。轻型亚组、中型亚组、重型亚组患者TSH水平、TPOAb阳性率、TgAb阳性率依次升高,FT_(3)、FT 4水平依次降低(均P<0.05)。中型亚组、重型亚组TPOAb阳性率明显高于轻型亚组,重型亚组TgAb阳性率明显高于轻型亚组(均P<0.05)。结论老年人甲状腺激素及甲状腺自身抗体水平与急性缺血性脑卒中的发病及严重程度有关,其中TPOAb水平升高、FT_(3)水平降低的老年人发生急性缺血性脑卒中发病的风险增加。

Objective To explore the relationship of thyroid hormone and thyroid autoantibody levels with the incidence and severity of acute ischemic stroke in the elderly.Methods Two hundred elderly patients with acute ischemic stroke were enrolled as stroke group,and another 200 concurrent healthy check-up elders were enrolled as control group.Besides,according to the scoring criteria of the National Institute of Health Stroke Scale,the stroke group were divided into mild subgroup,moderate subgroup and severe subgroup.The general data,blood lipid level,serum thyroid hormone(free triiodothyronine[FT_(3)],free tetraiodothyronine[FT 4],thyroid-stimulating hormone[TSH])level,thyroid autoantibody(thyroid peroxidase antibody[TPOAb]and thyroglobulin antibody[TgAb])level were compared between the two groups.The influencing factors of developing acute ischemic stroke in the elderly were analyzed by using the Logistic regression model.The levels of thyroid hormone and thyroid autoantibody were compared between patients with different severities of acute ischemic stroke.Results The stroke group exhibited higher proportion of cases with a history of atrial fibrillation,elevated levels of TPOAb,TgAb,TC and TSH,and decreased FT_(3)level as compared with the control group(all P<0.05).The results of multivariate Logistic regression analysis showed that elevated TPOAb level and atrial fibrillation were the independent risk factors for developing acute ischemic stroke in the elderly,and elevated FT_(3)level was the protective factor(all P<0.05).TSH level,TPOAb-positive rate,and TgAb-positive rate increased and the levels of FT_(3)and FT 4 decreased in the order of the mild,moderate and severe subgroups(all P<0.05).The moderate and severe subgroups yielded significantly higher TPOAb-positive rate than the mild subgroup,the severe subgroup produced significantly higher TgAb-positive rate than the mild subgroup(all P<0.05).Conclusion The levels of thyroid hormone and thyroid autoantibody correlate with the incidence and severity of acute ischemic stroke in the elderly,and elderly people with elevated TPOAb level or decreased FT_(3)level have increased risk for the occurrence of acute ischemic stroke.