Shi Zhenghao, Zhang Xuting, Chen Zhicai, Liebeskind David S, Lou Min
Department of Neurology, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
Int J Stroke. 2014 Aug;9(6):735-40. doi: 10.1111/ijs.12177. Epub 2013 Sep 12.
Previous studies have shown that hyperthyroidism was related to Moyamoya disease and intracranial artery stenosis. However, it is not clear whether thyroid hormone or thyroid autoantibodies was associated with them.
AIMS AND/OR HYPOTHESIS: Thyroid autoimmunity was previously shown to be associated with Moyamoya disease. Our study aimed to investigate the association between thyroid autoantibodies and intracranial large artery stenosis in young ischemic stroke patients with apparent euthyroid states.
We retrospectively reviewed first-onset ischemic stroke patients (age ≤55 years old) consecutively admitted to a single academic center. Intracranial large artery stenosis was defined as ≥50% luminal diameter narrowing. We compared demographic profiles, risk factors (age, hypertension, diabetes, current smoker, atrial fibrillation, hyperlipidemia), thyroid function test, and thyroid autoantibodies including antithyroperoxidase antibody and antithyroglobulin antibody between patients with and without intracranial large artery stenosis. We also performed multivariate logistic regression analysis to evaluate the association between thyroid autoantibodies and intracranial large artery stenosis.
A total of 351 patients were analyzed. The mean age of the patients was 47·0 ± 7·7 (range, 10-55 years), and 252 (71·8%) patients were male. We identified intracranial large artery stenosis in 121 (34·5%) patients. Patients with intracranial large artery stenosis showed a higher frequency of elevated antithyroperpxidase antibody levels in comparison with nonintracranial large artery stenosis group (16·5% vs. 3·9%, P < 0·001). After adjusting for covariates, the presence of elevated antithyroperpxidase antibody levels (odds ratio: 5·318; 95% confidence interval: 2·157-13·110, P < 0·001), age (odds ratio: 1·037; 95% confidence interval: 1·002-1·073, P = 0·039), and atrial fibrillation (odds ratio: 0·091; 95% confidence interval: 0·011-0·756, P = 0·027) was independently associated with intracranial large artery stenosis.
Thyroid autoantibodies may be associated with the presence of intracranial large artery stenosis in young stroke patients, potentially providing insight on immune pathogenesis of intracranial large artery stenosis.
既往研究表明，甲状腺功能亢进与烟雾病及颅内动脉狭窄有关。然而，尚不清楚甲状腺激素或甲状腺自身抗体是否与之相关。
目的和/或假设：既往研究显示甲状腺自身免疫与烟雾病有关。我们的研究旨在调查甲状腺自身抗体与甲状腺功能正常的年轻缺血性卒中患者颅内大动脉狭窄之间的关联。
我们回顾性分析了连续入住单一学术中心的首次发生缺血性卒中患者（年龄≤55岁）。颅内大动脉狭窄定义为管腔直径狭窄≥50%。我们比较了有和没有颅内大动脉狭窄患者的人口统计学特征、危险因素（年龄、高血压、糖尿病、当前吸烟者、心房颤动、高脂血症）、甲状腺功能检查以及甲状腺自身抗体，包括抗甲状腺过氧化物酶抗体和抗甲状腺球蛋白抗体。我们还进行了多因素逻辑回归分析，以评估甲状腺自身抗体与颅内大动脉狭窄之间的关联。
共分析了351例患者。患者的平均年龄为47.0±7.7岁（范围为10 - 55岁），252例（71.8%）为男性。我们在121例（34.5%）患者中发现了颅内大动脉狭窄。与非颅内大动脉狭窄组相比，颅内大动脉狭窄患者抗甲状腺过氧化物酶抗体水平升高的频率更高（16.5%对3.9%，P<0.001）。在对协变量进行调整后，抗甲状腺过氧化物酶抗体水平升高（比值比：5.318；95%置信区间：2.157 - 13.110，P<0.001）、年龄（比值比：1.037；95%置信区间：1.002 - 1.073，P = 0.039）和心房颤动（比值比：0.091；95%置信区间：0.011 - 0.756，P = 0.027）与颅内大动脉狭窄独立相关。
甲状腺自身抗体可能与年轻卒中患者颅内大动脉狭窄的存在有关，这可能为颅内大动脉狭窄的免疫发病机制提供见解。
