游离三碘甲状腺原氨酸与急性脑卒中预后的关系

Relationship between free triiodothyronine and prognosis of acute stroke

目的 探讨急性脑卒中患者入院时血清甲状腺激素浓度与临床特征和功能结局的关系。方法 选取2018年6月至2021年6月间入住新乡医学院第一附属医院的427例急性脑卒中患者,入院时评估血清促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)和游离甲状腺素(FT4),入院时使用美国国立卫生研究院急性脑卒中量表(NIHSS)和出院时使用改良的Rankin量表(mRS)评估神经系统严重程度和预后情况。结果 预后良好组251例,预后不良组176例,两组年龄、性别、FT3、血脂、房颤、心源性中风、NIHSS评分、血糖及PVH分级比较差异具有统计学意义(P<0.05)。采用Cox比例风险模型分析,年龄、FT3、NIHSS评分是影响患者预后的危险因素(P<0.05)。FT3预测急性脑卒中预后曲线下面积(AUC)为0.915,灵敏度为0.928,特异度0.887。根据入院时血清FT3水平的四分位数对患者进行分组,Q1、Q2、Q3及Q4患者中性别、血脂异常频率、年龄、NIHSS评分、PVH分级、房颤和心源性中风亚型比较差异具有统计学意义(P<0.05)。以血清FT3水平处于最高四分位数(Q4)区间的患者为参考,将随访期间预后情况(0~2分=0,3~6分=1)作为因变量纳入Cox回归模型中,血清FT3水平处于最低,与Q2,Q3相比较,FT3四分位数区间(Q1)的患者的频率明显更高,差异具有统计学意义(P<0.05);在校正风险因素和合并症后,其他两组(Q2,Q3)与最高四分位数(Q4)组患者相比差异无统计学意义(P>0.05)。结论 入院时血清FT3是评价急性脑卒中后临床严重程度、功能结果和死亡率的有效指标之一,其预后价值值得进一步研究。

Objective To explore the relationship between serum thyroid hormone concentration with clinical characteristics and functional outcomes in patients with acute stroke. Methods Retrospectively enrolled 427 acute stroke patients admitted to the First Affiliated Hospital of Xinxiang Medical College from June 2018 to June 2021,Serum thyroid-stimulating hormone(TSH),free triiodothyronine(FT3)and free thyroxine(FT4)were assessed upon admission,used the National Institutes of Health Stroke Scale(NIHSS)on admission and the modified Rankin Scale(mRS)on discharge to assess the severity of the nervous system and prognosis. Results There were 251 cases in the good prognosis group and 176 cases in the poor prognosis group,there were significant differences in age,gender,FT3,blood lipid,atrial fibrillation,cardiogenic stroke,NIHSS score,blood sugar and PVH grade between the two groups(P<0.05). The Cox proportional hazards model was used to analyze,and age,FT3 and NIHSS score were the risk factors affecting prognosis(P<0.05). The area under the curve(AUC)of FT3 in predicting the prognosis of acute stroke was 0.915,the sensitivity was 0.928,and the specificity was 0.887. Patients were grouped according to the quartiles of serum FT3levels at admission,and there were statistically significant differences in gender,dyslipidemia frequency,age,NIHSS score,PVH grade,atrial fibrillation and cardiogenic stroke subtype among Q1,Q2,Q3 and Q4 patients(P<0.05). Taking the patients whose serum FT3 level was in the highest quartile(Q4)interval as a reference,the prognosis during the follow-up period(0-2 points=0,3-6 points=1)was included in the Cox regression model as the dependent variable,the serum FT3 level was at the lowest,and the frequency of patients in the FT3quartile interval(Q1)was significantly higher compared with Q2 and Q3,and the difference was statistically significant(P<0.05);after adjusting for risk factors and comorbidities,the other two group(Q2,Q3)had no statistical significance compared with the highest quartile(Q4)group(P>0.05). Conclusion Serum FT3 on admission is one of the effective indicators to evaluate clinical severity,functional outcome and mortality after acute stroke,and its prognostic value and potential therapeutic utility deserve further study in future studies.