亚临床甲状腺功能减退症与急性缺血性卒中患者颈动脉粥样硬化的相关性

摘要

Objective To investigate the correlation between subclinical hypothyroidism (SCH) and carotid atherosclerosis in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke admitted to Nanjing Shengze Hospital Affiliated to Nanjing Medical University from July 2014 to July 2017 were enrolled retrospectively.SCH was defined as elevated levels of serum thyroid stimulating-hormone (TSH),but the free thyroxine (FT4) and free-triiodothyronine (FT3) levels were normal.Carotid plaque and carotid stenosis were assessed using carotid ultrasound.Multivariate logistic regression analysis was used to determine the correlation between SCH and carotid atherosclerosis.Resuts A total of 176 patients with acute ischemic stroke were enrolled,including 81 females and 95 males;36 complicated with SCH,126 complicated with carotid atherosclerotic plaques,and 9 had carotid stenosis.High-density lipoprotein cholesterol (1.36±0.48 mmol/L vs.1.18 ± 0.30 mmol/L;t =2.090,P =0.039) and TSH (6.29[5.44-7.01]mU/L vs.1.87[1.31-2.67] mU/L;Z =9.243,P =0.001) levels in the SCH group were significantly higher than those in the non-SCH group.There were significant differences in age (73.5[65.0-80.0]years vs.68.0[56.0-75.0]years;Z =2.707,P=0.007),stroke etiology classification (x2 =9.270,P=0.038),TSH level (2.19[1.47-3.72]mU/L vs.2.18[1.24-2.62]mU/L;Z=3.230,P=0.001),and the proportion of patients with SCH (26.98％ vs.4.00％;x2 =11.622,P =0.001) between the plaque group and the non-plaque group.There was no statistical difference in demographic and clinical data between the stenosis group and the non-stenosis group (all P ＞0.05).Multivariatelogistic regression analysis showed that advanced age (odds ratio 1.050,95％ confidence interval 1.014-1.088;P =0.006) and SCH (odds ratio 5.328,95％ confidence interval 1.322-21.468;P =0.019) were the independent risk factors for carotid atherosclerotic plaques.Conclusion Advanced age and SCH were the independent risk factors for carotid plaque in patients with acute ischemic stroke.%目的 探讨亚临床甲状腺功能减退症(subclinical hypothyroidism,SCH)与急性缺血性卒中患者颈动脉粥样硬化的相关性.方法 回顾性纳入2014年7月至2017年7月在南京医科大学附属江苏盛泽医院住院的急性缺血性卒中患者.SCH定义为血清促甲状腺激素(thyroid stimulating hormone,TSH)水平升高,但游离甲状腺素(free thyroxine,FT4)和游离三碘甲腺原氨酸(free triiodothyronine,FT3)水平正常.应用颈动脉超声评估颈动脉斑块及颈动脉狭窄.采用多变量logistic 回归分析确定SCH与颈动脉粥样硬化的相关性.结果 共纳入176例急性缺血性卒中患者,男性95例,女性81例;36例伴有SCH,126例存在颈动脉粥样硬化斑块,9例存在颈动脉狭窄.SCH组高密度脂蛋白胆固醇[(1.36±0.48) mmol/L对(1.18±0.30) mmol/L;t=2.090,P=0.039]和TSH[6.29(5.44～7.01)mU/L对1.87(1.31 ～2.67) mU/L;Z=9.243,P=0.001]水平显著高于非SCH组.斑块组年龄[73.5(65.0 ～ 80.0)岁对68.0(56.0～75.0)岁;Z=2.707,P=0.007]、卒中病因学分型(2=9.270,P=0.038)、TSH水平[2.19(1.47～3.72) mU/L对2.18(1.24 ～ 2.62) mU/L;Z=3.230,P =0.001)以及SCH患者的构成比(26.98％对4.00％;x2=11.622,P=0.001)与无斑块组差异有统计学意义.狭窄组人口统计学及临床资料与非狭窄组差异均无统计学意义(P均＞0.05).多变量logistic回归分析显示,高龄(优势比1.050,95％可信区间1.014～1.088;P=0.006)和SCH(优势比5.328,95％可信区间1.322～21.468;P=0.019)为存在颈动脉粥样硬化斑块的独立危险因素.结论 高龄和SCH是急性缺血性卒中患者存在颈动脉斑块的独立危险因素.