亚临床甲状腺功能亢进症是缺血性脑卒中后功能预后不良的危险因素。
Subclinical hyperthyroidism is a risk factor for poor functional outcome after ischemic stroke.
机构信息
Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany.
出版信息
Stroke. 2013 May;44(5):1446-8. doi: 10.1161/STROKEAHA.113.000833. Epub 2013 Mar 12.
BACKGROUND AND PURPOSE
Subclinical hyperthyroidism is associated with adverse cardiovascular events, including stroke and atrial fibrillation. However, its impact on functional outcome after stroke remains unexplored.
METHODS
A total of 165 consecutively recruited patients admitted for ischemic stroke were included in this observational prospective study. Blood samples were taken in the morning within 3 days after symptom onset, and patients were divided into the following 3 groups: subclinical hyperthyroidism (0.1< thyroid-stimulating hormone ≤ 0.44 μU/mL), subclinical hypothyroidism (2.5 ≤ thyroid-stimulating hormone <20 μU/mL), and euthyroid state (0.44< thyroid-stimulating hormone <2.5 μU/mL). Patients with overt thyroid dysfunction were excluded. Follow-up took place 3 months after stroke. Primary outcome was functional disability (modified Rankin Scale), and secondary outcome was level of dependency (Barthel Index). Ordinal logistic regression analysis was used to adjust for possible confounders. Variables previously reported to be affected by thyroid function, such as atrial fibrillation, total cholesterol, or body mass index, were included in an additional model.
RESULTS
Nineteen patients (11.5%) had subclinical hyperthyroidism, and 23 patients (13.9%) had subclinical hypothyroidism. Patients with subclinical hyperthyroidism had a substantially increased risk of functional disability 3 months after stroke compared with subjects with euthyroid state (odds ratio, 2.63; 95% confidence interval, 1.02-6.82, adjusted for age, sex, smoking status, and time of blood sampling). The association remained significant, when including the baseline NIHSS, TIA, serum CRP, atrial fibrillation, body mass index, and total cholesterol as additional variables (odds ratio, 3.95; 95% confidence interval, 1.25-12.47), and was confirmed by the secondary outcome (Barthel Index: odds ratio, 9.12; 95% confidence interval, 2.08-39.89).
CONCLUSIONS
Subclinical hyperthyroidism is a risk factor for poor outcome 3 months after ischemic stroke.
背景与目的
亚临床甲状腺功能亢进与不良心血管事件相关，包括中风和心房颤动。然而，其对中风后功能结局的影响仍未得到探索。
方法
本观察性前瞻性研究共纳入 165 例连续招募的缺血性中风患者。在症状发作后 3 天内的早晨采集血样，患者被分为以下 3 组：亚临床甲状腺功能亢进（0.1<促甲状腺激素≤0.44μU/mL）、亚临床甲状腺功能减退（2.5≤促甲状腺激素<20μU/mL）和甲状腺功能正常状态（0.44<促甲状腺激素<2.5μU/mL）。排除有显性甲状腺功能障碍的患者。中风后 3 个月进行随访。主要结局为功能残疾（改良 Rankin 量表），次要结局为依赖程度（巴氏指数）。有序逻辑回归分析用于调整可能的混杂因素。将先前报道受甲状腺功能影响的变量（如心房颤动、总胆固醇或体重指数）纳入额外模型中。
结果
19 例（11.5%）患者存在亚临床甲状腺功能亢进，23 例（13.9%）患者存在亚临床甲状腺功能减退。与甲状腺功能正常状态的患者相比，亚临床甲状腺功能亢进患者中风后 3 个月的功能残疾风险显著增加（优势比，2.63；95%置信区间，1.02-6.82，经年龄、性别、吸烟状态和采血时间调整）。当将基线 NIHSS、TIA、血清 CRP、心房颤动、体重指数和总胆固醇作为附加变量纳入模型时，该关联仍然显著（优势比，3.95；95%置信区间，1.25-12.47），且通过次要结局（巴氏指数：优势比，9.12；95%置信区间，2.08-39.89）得到证实。
结论
亚临床甲状腺功能亢进是缺血性中风后 3 个月预后不良的危险因素。
Zotero 插件