缺血性卒中静脉溶栓后高水平的血甲状腺激素水平与良好预后相关

刘威鹏.缺血性卒中静脉溶栓后高水平的血甲状腺激素水平与良好预后相关[J].内科急危重症杂志,2021,27(6):468-471

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DOI：10.11768/nkjwzzzz20210606

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作者	单位	E-mail
刘威鹏	上海交通大学医学院附属新华医院急诊科	panshuming@xinhuamed.com.cn

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中文摘要:

摘要目的：探讨接受静脉内重组组织型纤溶酶原激活剂（rt-PA）治疗的急性缺血性卒中(AIS)患者溶栓后血甲状腺激素水平与6个月后预后的关系。方法：收集2010年1月-2019年12月在上海交通大学医学院附属新华医院卒中中心接受静脉rt-PA溶栓治疗的AIS中患者397例的人口统计学特征、既往病史、临床特征及入院时血清甲状腺激素水平等数据。随访6个月采用改良Rankin量表（mRS）评估预后，若出现死亡或残疾，改良mRS评分≥2则定义为预后不良，采用Logistic逐步回归模型对可能影响患者预后的因素进行分析。结果: 预后良好的患者(mRS评分为0~1分)血清游离三碘甲状腺原氨酸（FT3）水平高于预后不良的患者(mRS评分为2~6分)，Logistic逐步回归模型分析显示血清FT3水平是影响患者短期预后的独立保护因素。ROC曲线提示，血清FT3水平用来预测患者预后的准确性并不高，曲线下面积仅为（0.684±0.031）。Pearson相关性分析发现，血清FT3水平和缺血性卒中患者病情的严重程度呈负相关(r=-0.149,P=-0.003)，与预后良好呈正相关（r=0.183,P=0.000）。结论：血清FT3水平可能是影响接受rT-PA静脉溶栓治疗的缺血性卒中患者预后的独立保护因素，良好的预后与高水平的血清FT3相关，但相关性不强。

英文摘要:

Abstract Objective: To evaluate the relationship between serum thyroid hormone level and 6-month clinical outcome in patients who received intravenous re-combinant human tissue plasminogen activator (rt-PA) for the treatment of acute ischemic stroke (AIS). Methods: Data on demographic characteristics, past medical history, clinical features, and serum thyroid hormone level at admission were collected from 397 patients who received intravenous rt-PA thrombolytic therapy in The Stroke Center of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2010 to December 2019. After 6 months of follow-up, the modified Rankin scale (mRS) was used to evaluate the outcome. Adverse clinical outcome was defined as death or dependence(mRS≥2). Stepwise Logistic regression models were used to analyze potential factors affecting the outcome. Results: Serum FT3 level was higher in the patients with excellent outcome(mRS 0 to 1) than in patients with poor outcome (mRS 2 to 6). Forward stepwise multivariate Logistic regression analysis revealed that serum FT3 levels were independently associated with the outcome of patients. The receiver operating characteristic (ROC) curve analysis demonstrated serum FT3 level had a low power for predicting outcome as suggested by the area under ROC curve (AUC) of 0.684±0.031. Pearson correlation analysis found that serum FT3 level was negatively correlated with the severity of stroke (r=-0.149, P=-0.003) and positively correlated with excellent prognosis(r=0.183, P=0.000). Conclusion: Serum FT3 level may be an independent protective factor affecting the prognosis of ischemic stroke patients receiving rt-PA intravenous thrombolytic therapy. Excellent outcome is associated with high serum FT3 level, but the correlation is not strong.