脑卒中后认知障碍与内分泌激素变化的关系

The relationship between the cognitive impairment after stroke and the hormone levels

目的探讨不同认知水平的脑卒中患者体内内分泌激素水平与认知障碍发生的关系。方法选取2012年12月至2013年12月入住内蒙古医科大学附属医院神经内科的患者,根据入组标准选取脑梗死组患者108例和脑出血组患者40例,选择同期神经系统检查无确诊脑血管及内分泌系统疾病者作为对照组(20例)。使用蒙特利尔认知评估量表(MoCA)评估脑梗死组患者的认知功能并分为认知功能高水平组(MoCA评分≥23分,41例)、中水平组(MoCA评分≥15分且<23分,38例)、低水平组(MoCA评分<15分,29例)3组。全部研究对象统一采集血标本并测定其血清三碘甲状腺原氨酸(T_(3))、血清甲状腺素(T_(4))、游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、促甲状腺素(TSH)、血清泌乳素(PRL)、血清促卵泡刺激素(FSH)、血清促黄体生成素(LH)、血清生长激素(GH_(2))、促肾上腺皮质激素(ACTH)和皮质醇(CORT)水平。采用两独立样本t检验及Mann-WhitneyU检验比较脑梗死组、脑出血组与对照组间以及不同认知功能水平组间激素水平的差异,使用Logistic回归分析法分析脑出血认知功能与各激素水平变化间关系。结果与对照组比较,脑梗死组出现了T_(4)、FT_(3)、GH_(2)水平降低[(7.36±1.74)μg/dl vs(8.25±1.24)μg/dl;(2.57±0.57)pg/ml vs(2.94±0.43)pg/ml;0.88(0.11,23.02)ng/ml vs 0.94(0.03±1.31)ng/ml],差异均具有统计学意义(t=3.147,P=0.011;t=2.848,P<0.001;Z=3.333,P=0.043),脑出血组出现了FT_(3)、GH_(2)水平降低[(2.55±0.49)pg/ml vs(2.94±0.43)pg/ml;0.35(0.88,1.13)ng/mlvs0.94(0.03,1.31)ng/ml]和TSH、CORT水平升高[3.89(0.88,24.17)μIU/mlvs2.98(0.47,22.31)μIU/ml;539.72(287.56,971.53)nmol/Lvs489.30(230.67,896.45)nmol/L],差异均具有统计学意义(t=6.179,P<0.001;Z=-2.322,P=0.023;Z=2.216,P<0.001;Z=2.124,P=0.017),余激素水平比较差异均无统计学意义(P均>0.05)。脑梗死后认知功能高、中、低水平组间其T,变化存在差异,FT,在认知功能高中组间、高低组间,ACTH在认知功能中低组间、高低组间变化存在差异,差异均具有统计学意义(P均<0.017)。Logistic回归分析显示,脑出血患者的T_(3)、FT_(3)水平为卒中后认知障碍的危险因素(回归系数=0.750、1.972,OR=0.992、8.162,P=0.002、0.037)。结论急性脑卒中后患者分别出现甲状腺功能、ACTH、CORT和GH,水平的变化,且变化趋势与卒中后认知功能改变呈一定相关性。

Objective To investigate the relationship between endocrine hormone levels and cognitive impairment in stroke patients with varying degrees of cognitive function.Methods Patients admitted to the Neurology Department of Inner Mongolia Medical University Affiliated Hospital between December 2012 and December 2013 were enrolled in the study.Based on the inclusion criteria,108 cases of cerebral infarction and 40 cases of cerebral hemorrhage were included as the stroke group,while another 20 patients without diagnosed cerebrovascular or endocrinological disorders were included as the control group.The Montreal Cognitive Assessment(MoCA)was used to assess the cognitive function of stroke patients,and they were classified into three subgroups:high-level cognitive function group(MoCA score≥23,41 cases),medium-level cognitive function group(MoCA score≥15 and<23,38 cases),and low-level cognitive function group(MoCA score<15,29 cases).All participants'blood samples were collected for the measurement of serum levels of triodothyronine(T_(3)),tetraiodothyronine(T_(4)),free triodothyronine(FT_(3)),free thyroxine(FT_(4)),thyroid-stimulating hormone(TSH),prolactin(PRL),follicle-stimulating hormone(FSH),luteinizing hormone(LH),human growth hormone(GH_(2)),adrenocorticotropic hormone(ACTH),and cortisol(CORT).The hormone levels among the stroke group(cerebral infarction and cerebral hemorrhage)and the control group,as well as among different cognitive function level subgroups,were compared using independentsamples t-tests and Mann-Whitney U tests.Furthermore,Logistic regression analysis was performed to examine the relationship between cognitive function and hormone level changes in the cerebral hemorrhage group.Results Compared with the control group,the levels of T4,FTs,and GH,decreased in the ischemic stroke group[(7.36±1.74)μg/dl vs(8.25±1.24)μg/dl;(2.57±0.57)pg/ml vs(2.94±0.43)pg/ml;0.88(0.11,23.02)ng/ml vs 0.94(0.03,1.31)ng/ml],with statistically significant differences(t=3.147,P=0.011;t=2.848,P<0.001;Z=3.333,P=0.043).There were no significant differences in the levels of other hormones(P>0.05).The hemorrhagic stroke group showed decreased levels of FT;GH[(2.55±0.49 pg/ml vs 2.94±0.43 pg/ml);(0.35(0.88,1.13)ng/ml vs 0.94(0.03,1.31)ng/ml],and increased levels of TSH,CORT[(3.89(0.88,24.17)μIU/ml vs 2.98(0.47,22.31)μIU/ml);(539.72(287.56,971.53)nmol/L vs 489.30(230.67,896.45)nmol/L],with statistically significant differences(t-6.179,P<0.001;Z=2.322,P=0.023;Z-2.216,P<0.001;Z-2.214,P-0.017).There were no significant differences in the levels of other hormones(P>0.05).Differences in T,and FT,were observed among different cognitive function levels in the ischemic stroke group,while differences in ACTH were observed between the middle-low and high-low cognitive function subgroups.These differences were statistically significant(P<0.017).Logistic regression analysis showed that the levels of T,and FT,in hemorrhagic stroke patients were risk factors for post-stroke cognitive impairment(β-0.750,1.972;OR-0.992,8.162;P-0.002,0.037).Conclusion Patients with acute cerebrovascular disease showed changes in thyroid function,cortisol and adrenocorticotropic hormone levels,and growth hormone levels,and these changes were correlated with post-stroke cognitive impairment.