老年急性缺血性脑卒中患者早期功能预后与甲状腺功能变化的相关性

摘要

Objective To study the association between early functional outcome and serum thyroid hormone level in elderly acute ischemic stroke (AIS) patients.Methods Two hundred and twenty-four AIS patients admitted to our hospital from May to December 2016 were divided into good functional outcome group (n=166) and poor functional outcome group (n=58) according to their mRS score.The serum levels of FT3,FT4,TSH were measured.The patients were further divided into FT3≤4.05 pmol/L,FT3 4.06-4.46 pmol/L,and FT3＞4.46 pmol/L.The association between early functional outcome and serum levels of FT3,FT4,TSH in elderly AIS patients were analyzed by univariate and multivariate logistic analysis.Results The AIS was severer,the BMI and incidence of AF were higher,the number of WBC was greater,the serum FT3 and CRP levels were higher in poor functional outcome group than in good functional outcome group (P＜0.05,P＜0.01).The rate of poor functional outcome was significantly higher in FT3≤4.05 pmol/L than in FT3 4.06-4.46 pmol/L and FT3 ＞4.46 pmol/L (39.5％ vs 22.2％,39.5％ vs 15.8％,P=0.003).Univariate logistic regression analysis and multivariate logistic regression analysis showed that FT3 was an independent risk factor for early poor functional outcome in AIS patients.Concision The lower the serum FT3 level on admission is,the poorer the early functional outcome is in AIS patients.%目的 调查老年急性缺血性脑卒中患者血清甲状腺激素水平的变化与早期功能结局之间的相关性.方法 连续性纳入2016年5～12月卒中登记的老年急性缺血性脑卒中患者224例,根据改良的Rankin量表评分分为预后良好组166例及预后不良组58例.检测游离三碘甲状腺原氨酸(FT3)、血清游离甲状腺素、促甲状腺激素水平.按FT3水平将患者分为低位水平(FT3≤4.05 pmol/L)、中位水平(FT3 4.06～4.46 pmol/L)和高位水平(FT3＞4.46 pmol/L).分别进行单因素及多因素logistic回归分析.结果 预后不良组与预后良好组入院时美国国立卫生研究院卒中量表评分、体质量指数、心房颤动、白细胞计数、FT3水平、C反应蛋白等比较,差异有统计学意义(P＜0.05,P＜0.01).FT3低位水平患者较FT3中位水平和高位水平患者预后不良比例明显增高(39.5％ vs 22.2％、15.8％,P=0.003).调整相关危险因素后,FT3是患者早期不良预后的独立预测指标.结论 急性缺血性脑卒中患者入院时FT3越低,预后越差.