高血压性脑出血患者临床结局与神经内分泌因子的关系

The Relationship Between Clinical Outcome and Neuroendocrine Factorsin Patients with Hypertensive Cerebral Hemorrhage

目的探讨分析高血压性脑出血患者临床结局与神经内分泌因子的关系。方法选取我院2019年5月至2022年5月收治的246例高血压脑出血患者作为观察组,并选取同期108例健康体检者作为对照组。入院时采用放射免疫法检测神经内分泌因子[游离型甲状腺素(free thyroxine,FT_(4))、游离型三碘甲状腺原氨酸(free triiodothyronine,FT_(3))、促甲状腺激素(thyroid stimulating hormone,TSH)、促肾上腺皮质激素(adrenocorticotrophic hormone,ACTH)、皮质醇(cortisol,COR)]水平。随访截止至2023年5月31日,以末次随访或死亡为终点,记录患者临床结局,采用多因素Cox分析患者临床结局与神经内分泌因子的关系。结果观察组患者血清FT_(4)、TSH、ACTH、COR水平均高于对照组(P<0.05),而血清FT_(3)水平低于对照组(P<0.05)。ROC曲线结果显示,血清FT_(3)、FT_(4)、TSH、ACTH、COR诊断高血压脑出血患者死亡的最佳截断值分别为:4.25pmol/L、16.75pmol/L、3.12mIU/L、22.67pg/mL、287.43ng/mL;其曲线下面积分别为0.71、0.72、0.76、0.73、0.75;灵敏度分别为76.43%、75.28%、78.39%、74.56%、77.25%;特异性分别为68.75%、73.46%、70.59%、90.23%、71.38%。入院时GCS评分<8分、破脑入室、出院时GOS评分<3分、FT_(3)<4.25pmol/L、FT_(4)≥16.75pmol/L、TSH≥3.12mIU/L、ACTH≥22.67pg/mL、COR≥287.43ng/mL患者平均生存时间低于入院时GCS评分≥8分、无破脑入室、出院时GOS评分≥3分、FT_(3)≥4.25pmol/L、FT_(4)<16.75pmol/L、TSH<3.12mIU/L、ACTH<22.67pg/mL、COR<287.43ng/mL患者(P<0.05)。多因素Cox回归显示,破入脑室(HR=1.687,95%CI 1.267~2.246)、FT_(3)降低(HR=2.28,95%CI 1.472~3.529)、FT_(4)升高(HR=2.552,95%CI 1.610~4.045)、TSH升高(HR=2.787,95%CI 1.497~5.188)、ACTH升高(HR=3.476,95%CI 1.828~6.612)、COR升高(HR=2.389,95%CI 1.467~3.892)是影响高血压脑出血患者死亡的重要危险因素(P<0.05)。结论高血压脑出血患者血清FT_(3)水平降低,血清FT_(4)、ACTH、COR水平升高,血清FT_(3)、FT_(4)、TSH、ACTH、COR等神经内分泌因子是高血压脑出血患者临床结局的重要影响因素,对评估患者临床结局具有重要参考价值。

Objective To investigate the relationship between clinical outcome and neuroendocrine factors in patients with hypertensive cerebral hemorrhage.Methods 246 patients with hypertensive cerebral hemorrhage admitted to our hospital from May,2019 to May,2022 were selected as the observation group,while 108 healthy subjects were selected as the control group during the same period.The neuroendocrine factors(free Thyroxine,FT_(4))and free triiodothyronine were detected by radioimmunoassay at admission.FT_(3),thyroid stimulating hormone(TSH),adrenocorticotrophic Hormone(ACTH),and cortisol(COR).Patients were followed up until May 31,2023,with the last follow-up or death as the end point.The clinical outcomes of patients were recorded,and the relationship between clinical outcomes and neuroendocrine factors was analyzed by multi-factor Cox method.Results Serum FT_(4),TSH,ACTH and COR levels in the observation group were higher than those in the control group(P<0.05),while serum FT_(3) levels were lower than those in the control group(P<0.05).ROC curve showed that the optimal cut-off values of serum FT_(3),FT_(4),TSH,ACTH and COR in diagnosing the death of hypertensive intracerebral hemorrhage patients were 4.25 pmol/L,16.75pmol/L,3.12mIU/L,22.67pg/mL and 287.43 ng/mL,respectively.The areas under the curve were 0.71,0.72,0.76,0.73 and 0.75,respectively.The sensitivity were 76.43%,75.28%,78.39%,74.56%and 77.25%,respectively.The specificity were 68.75%,73.46%,70.59%,90.23%and 71.38%,respectively.Upon admission,GCS score was<8 points,the brain was broken and the GOS score was<3 points,FT_(3)<4.25pmol/L,FT_(4)≥16.75pmol/L,TSH≥3.12mIU/L,ACTH≥22.67pg/mL,COR≥287.43ng/mL,and the mean survival time of patients was lower than that at admission,while GCS score≥8,patients had no brain rupture,GOS score≥3,FT_(3)≥4.25pmol/L,FT_(4)<16.75pmol/L,TSH<3.12mIU/L,ACTH<22.67pg/mL,COR<287.43 ng/mL(P<0.05).Multivariate Cox regression showed that ventricular rupture(HR=1.687,95%CI 1.267-2.246),FT_(3) decreased(HR=2.28,95%CI 1.472-3.529),and FT_(4) increased(HR=2.552,95%CI 1.610-4.045),TSH increased(HR=2.787,95%CI 1.497-5.188),ACTH increased(HR=3.476,95%CI 1.828-6.612),COR increased(HR=2.389,95%CI 1.467-3.892)were important risk factors for death in patients with hypertensive cerebral hemorrhage(P<0.05).Conclusion Serum FT_(3) levels decrease in patients with hypertensive cerebral hemorrhage,while serum FT_(4),ACTH,COR levels increase.Serum FT_(3),FT_(4),TSH,ACTH,COR and other neuroendocrine factors are important factors affecting clinical outcomes in patients with hypertensive cerebral hemorrhage,and have important reference value for evaluating clinical outcomes.