上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2020, Vol. 40 ›› Issue (4): 478-.doi: 10.3969/j.issn.1674-8115.2020.04.010

• 论著·临床研究 • 上一篇    下一篇

甲状腺相关激素及抗体与缺血性脑卒中患者静脉溶栓的预后相关性研究

徐婧涵1，何欣威1，李 强1，包关水1, 2   

  1. 1. 上海交通大学医学院附属第九人民医院神经内科，上海200011；2. 上海交通大学医学院临床研究中心，上海200025
  • 出版日期:2020-04-28 发布日期:2020-05-22
  • 通讯作者: 包关水，电子信箱：baogs@163.com。
  • 作者简介:徐婧涵（1993—），女，硕士生；电子信箱：Xjhaniu@163.com。
  • 基金资助:
    上海市科学技术委员会科研计划项目（14411972200）；上海吴孟超医学科技基金项目（JJHXM-2019009）。

Study on the prognosis of intravenous thrombolysis in patients with ischemic strokethyroid-related hormones and antibodies

XU Jing-han, HE Xin-wei, LI Qiang, BAO Guan-shui   

  1. 1. Department of Neurology, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China; 2. Clinical Research Center , Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2020-04-28 Published:2020-05-22
  • Supported by:
    Scientific Research Program of the Shanghai Municipal Science and Technology Commission (14411972200); Program of Shanghai WU Meng-chao Medical Science Foundation (JJHXM-2019009).

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摘要： 目的·探索甲状腺相关激素及抗体与接受重组组织型纤溶酶原激活剂（recombinant tissue plasminogen activator，rt-PA）静脉溶栓治疗的缺血性脑卒中患者预后的关系。方法·回顾性连续纳入2012年5月—2018年8月在上海交通大学医学院附属第九人民医院神经内科接受rt-PA静脉溶栓治疗的缺血性脑卒中患者213例。入院时检测甲状腺相关激素及抗体，溶栓后24h评估颅内出血（intracranial hemorrhage，ICH）。随访3个月，通过改良Rankin量表（modified Rankin Scale，mRS）评估功能结局。采用Logistic回归分析甲状腺相关激素及抗体与功能结局、ICH的关系。结果·单因素回归分析，游离三碘甲腺原氨酸（free triiodothyronine，fT3）、总三碘甲腺原氨酸（total triiodothyronine，tT3）、总甲状腺素（total thyroxine，tT4）水平与不良功能预后相关（P0.000，P0.028，P0.000）；fT3、游离甲状腺素（free thyroxine，fT4）水平与ICH相关（P0.008，P0.014）。然而，对其他因素进行校正后，低fT3水平与不良预后独立相关（OR0.35，95% CI 0.138～0.890，P0.027）；fT3、fT4水平均与ICH无关。此外，fT3与脑卒中严重程度呈负相关（r-0.291，P0.000）。结论·低fT3水平与脑卒中的严重程度和功能结局相关。

关键词: 缺血性脑卒中, 静脉溶栓, 甲状腺相关激素, 功能结局, 颅内出血

Abstract:

Objective · To explore the association between thyroid-related hormones and antibodies and the prognosis of ischemic stroke patients treated with intravenous thrombolysis using recombinant tissue plasminogen activator (rt-PA). Methods · A total of 213 consecutive patients with ischemic stroke who underwent rt-PA intravenous thrombolysis in the Department of Neurology, Shanghai Ninth Peoples Hospital, Shanghai Jiao Tong University School of Medicine, were retrospectively included May 2012 to August 2018. Thyroid-related hormones and antibodies were tested on admission, and assessment of intracranial hemorrhage (ICH) was conducted 24 hours after thrombolysis. Functional outcomes were assessedmodified Rankin Scale (mRS) after 3 months of follow-up. The relationship between thyroid-related hormones and antibodies and the prognosis (including functional outcome and ICH) was analyzedlogistic regression analysis. Results · In univariate regression analysis, free triiodothyronine (fT3), total triiodothyronine, (tT3) and total thyroxine (tT4) levels were associated with poor functional prognosis (P0.000, P0.028, P0.000) and fT3, and free thyroxine (fT4) levels were associated with ICH (P0.008, P0.014). However, after adjustment for other variables, low fT3 levels were independently associated with poor prognosis (OR0.35, 95%CI 0.138-0.890, P0.027), and both fT3 and fT4 levels had nothing to do with ICH. In addition, fT3 was negatively correlated with stroke severity (r-0.291, P0.000). Conclusion · Low fT3 levels are associated with stroke severity and functional outcome.

Key words: ischemic stroke, intravenous thrombolysis, thyroid-related hormones, functional outcome, intracranial hemorrhage