Ambrosius W, Kazmierski R, Gupta V, Warot A Wencel, Adamczewska-Kociałkowska D, Błazejewska A, Ziemnicka K, Nowinski W L
Biomedical Imaging Lab, Agency for Science Technology and Research, Singapore.
Exp Clin Endocrinol Diabetes. 2011 Mar;119(3):139-43. doi: 10.1055/s-0030-1267918. Epub 2010 Nov 17.
Neuroendocrine changes are important processes which accompany critical illness, however, the number of clinical studies concentrating on the role of thyroid gland hormones in stroke pathogenesis is relatively small. The aim of this prospective study was to investigate the relation between free triiodothyronine (fT3) levels and the prognosis of patients with stroke.
The prospective study included 387 patients with acute (<24 h of symptoms onset) ischemic stroke consecutively admitted to Stroke Units. The subjects with known conditions that could interfere with thyroid gland metabolism were excluded. We analyzed: the routine blood tests, fT3, free thyroxine (fT4), thyroid-stimulating hormone (TSH) levels, unenhanced CT scans, initial clinical status (NIH Stroke Scale, NIHSS), 30- and 360- days outcome (modified Rankin Scale-mRS) and calculated the survival rate.
A higher NIHSS score was in the 1 (st) fT3 levels tertile, whereas a lower in the 3 (rd) fT3 levels tertile (p=0.006). The 30- and 360-days mRS scores showed that patients in the lowest fT3 tertile had more severe neurological impairment than those in the highest tertile (p=0.001 and p=0.03, respectively). A 1-year mortality of the patients with the first tertile fT3 levels was significantly higher than that of the patients with the third tertile hormone levels (p=0.008). Additionally, subjects with fT3 level in the lowest tertile demonstrated higher WBC counts and the ventricular system on Computed Tomography of head performed on admission to hospital was statistically more frequent compressed than that in the patients with fT3 level in the highest tertile (p=0.02 and p=0.03, respectively).
In acute stroke patients lower free T3 levels are an important factor related to unfavorable outcome, i. e., severe disability and death.
神经内分泌变化是危重病伴随的重要过程，然而，专注于甲状腺激素在中风发病机制中作用的临床研究数量相对较少。这项前瞻性研究的目的是调查游离三碘甲状腺原氨酸（fT3）水平与中风患者预后之间的关系。
这项前瞻性研究纳入了387例连续入住卒中单元的急性（症状发作<24小时）缺血性中风患者。排除已知可能干扰甲状腺代谢的疾病患者。我们分析了：血常规、fT3、游离甲状腺素（fT4）、促甲状腺激素（TSH）水平、平扫CT扫描、初始临床状态（美国国立卫生研究院卒中量表，NIHSS）、30天和360天结局（改良Rankin量表 - mRS）并计算生存率。
NIHSS评分在fT3水平最低三分位数组中较高，而在fT3水平最高三分位数组中较低（p = 0.006）。30天和360天的mRS评分显示，fT3水平最低三分位数组的患者比最高三分位数组的患者有更严重的神经功能缺损（分别为p = 0.001和p = 0.03）。fT3水平处于最低三分位数组的患者1年死亡率显著高于激素水平处于最高三分位数组的患者（p = 0.008）。此外，fT3水平处于最低三分位数组的受试者白细胞计数较高，入院时头部计算机断层扫描显示脑室系统受压在统计学上比fT3水平处于最高三分位数组的患者更频繁（分别为p = 0.02和p = 0.03）。
在急性中风患者中，较低的游离T3水平是与不良结局相关的重要因素，即严重残疾和死亡。
