老年人脑小血管病与甲状腺功能相关性研究

Relationship between cerebral small vessel disease and thyroid hormones in the elderly

目的探讨老年人脑小血管病与甲状腺功能的关系。方法连续纳入于2019年5月至2020年11月于北京医院老年医学部参加查体、有头部磁共振成像(MRI)及血清甲状腺功能检查的60岁以上的被试者314例进行横断面研究。脑小血管病组要求头部MRI达到以下标准:Fazekas评分≥3分;或Fazekas评分≥2分,合并1个腔隙;有新发皮层下梗死灶;有脑微出血。比较脑小血管病组(129例)和无脑小血管病组(对照组,185例)的甲状腺功能有无差异。结果脑小血管病组和对照组的甲状腺功能比较,游离三碘甲状腺原氨酸(FT3)水平差异有统计学意义(t=3.270,P=0.001)。有腔梗组和无腔梗组的FT3水平差异有统计学意义(t=3.106,P=0.002),有脑微出血组和无脑微出血组的FT3水平差异有统计学意义(t=2.125,P=0.034),脑白质高信号的Fazekas评分各组间反三碘甲状腺原氨酸(反T3)(F=3.092,P=0.027)、FT3(F=5.427,P=0.001)、游离甲状腺素(FT4)(F=2.646,P=0.049)水平差异有统计学意义。校正高脂血症、反T3、FT4后,年龄(OR=1.044,95%CI:1.022~1.067,P=0.000)、高血压(OR=0.533,95%CI:0.294~0.963,P=0.037)、FT3(OR=0.276,95%CI:0.159~0.478,P=0.000)与脑小血管病有关。结论老年人正常范围内较低的FT3水平与脑小血管病相关。

Objective To investigate the relationship between cerebral small vessel disease and thyroid hormones in the elderly.Methods A total of 314 subjects aged≥60 years with records of head magnetic resonance image(MRI),serum thyroid function tests and physical examinations collected in the Department of Health Care Neurology of Beijing Hospital from May 2019 to November 2020 were consecutively included for this cross-sectional study.Participants were assigned into the cerebral small vessel disease group if their head MRI presentations met the following standards:the Fazekas score≥3 points;the Fazekas score≥2 points,with 1 cavity;new subcortical infarcts;or cerebral microhemorrhage.Differences in thyroid function were compared between the cerebrovascular disease group(n=129)and the group without cerebrovascular disease(control group,n=185).Results A total of 314 subjects were enrolled,of whom 129 met the head MRI standards for cerebrovascular disease,and 185 who did not meet the standards entered the control group.Comparison of thyroid function found a statistically significant difference in FT3(t=3.270,P=0.001)between the two groups.As for the association of a specific type of cerebral small vessel disease with thyroid function,there was a statistically significant difference in the FT3 level between the lacunar infarction group and the non-lacunar infarction group(t=3.106,P=0.002)and between the cerebral microhemorrhage group and the non-cerebral microhemorrhage group(t=2.125,P=0.034).Groups with different Fazekas scores in white matter hyperintensity showed statistically significant differences in rT3(F=3.092,P=0.027),FT3(F=5.427,P=0.001)and FT4(F=2.646,P=0.049).After correction for hyperlipidemia,rT3 and FT4,it was found that age(OR=1.044,95%CI:1.022-1.067,P=0.000),hypertension(OR=0.533,95%CI:0.294-0.963,P=0.037)and FT3(OR=0.276,95%CI:0.159-0.478,P=0.000)were related to cerebral small vessel disease.Conclusions FT3 levels at the lower end of the normal range are associated with cerebral small vessel disease in the elderly.