甲状腺抗体与缺血性卒中发生及转归的关系

摘要

目的 探讨甲状腺抗体与缺血性卒中(CIS)发生、发展及临床转归的关系.方法 将382例CIS患者根据甲状腺抗体(TPOAb及TGAb)水平分为正常组、轻度增高组及明显增高组,比较三组患者一般资料及临床病情(NIHSS评分)的差异,并分析甲状腺抗体与CIS病情转归(mRS评分)的关系.结果 ①与抗甲状腺过氧化物酶抗体(TPOAb)正常组比较,TPOAb轻度增高组与TPOAb明显增高组的大动脉狭窄患者、入院时NIHSS≥8分及卒中1月、3月及1年mRS评分≥8分患者比例明显增高(P<0.05);②与抗甲状腺球蛋白抗体(TGAb)正常组比较,TGAb轻度增高组与TGAb明显增高组卒中1月、3月及1年mRS评分≥8分患者比例明显增高(P<0.05);③与预后良好组比较,预后不良组入院时、卒中14d NIHSS≥8分患者及TPOAb或TGAb阳性比例更高(P<0.01);④CIS患者伴发TPOAb或TGAb阳性,其卒中发生预后不良的风险更高(OR :9.980,95%CI :4.041~24.645,P<0.01)或(OR :2.529,95%CI :1.034~6.185,P=0.042).结论 甲状腺抗体TPOAb阳性及其水平可能与CIS合并头颈部大动脉狭窄、卒中后NIHSS评分及临床转归(mRS评分)有关;TPOAb和TGAb阳性可能是CIS患者预后不良的独立危险因素.%Objective? To investigate the relationship between thyroid autoantibodies and the occurrence and development of cerebral ischemic stroke(CIS) and its outcome.Method 382 patients with CIS were divided into normal group, mildly higher group and severely higher group according to the thyroid autoantibodies levels. Clinical information and modified Rankin Scale (mRS) scores were compared in these three groups.Results? ①Compared with the normal group of TPOAb, patients in mildly and severely higher groups were more likely to have large atherosclerotic stenosis. Moreover, the proportion of patients with NIHSS ≥ 8 in admission, and patients with mRS score ≥ 3 at 1 month, 3 months, and 1 year in these two groups were significantly increased (P<0.05) when compared with the normal group; ② Compared with the normal group of TGAb, the proportion of patients with mRS score ≥3 at 1 month, 3 months, and 1 year after stroke in mildly higher and severely higher groups were significantly increased (P<0.05);③Compared with the group of good functional outcome, patients in the poor functional outcome group were with a larger proportion of NIHSS scores ≥8 points at admission and at 14 day after stroke (P<0.01), and with more positive thyroid autoantibodies (P<0.001);④CIS patients with TPOAb and TGAb positive had increased risk of poor prognosis of stroke (odds ratio 9.980, 95%CI 4.041-24.645, P<0.01)or(odds ratio 2.529, 95%CI 1.034-6.185, P=0.042). Conclusion? Elevated thyroid antibodies (TPOAb or TGAb) may be associated with large atherosclerotic stenosis in CIS patients, and associated with both NIHSS scores and mRS scores. Postive TPOAb and TGAb may independently predict the poor prognosis of patients with CIS.