Department of Geriatric Medicine, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK,
J Neurol. 2014 Mar;261(3):533-45. doi: 10.1007/s00415-013-7231-5. Epub 2014 Jan 30.
Studies in non-stroke patients have shown an association between dysregulation of the hypothalamic-pituitary-adrenal axis and morbidity and mortality. We conducted a systematic review to evaluate cortisol levels in acute stroke and their associations with outcome. We searched MEDLINE and EMBASE for articles up to April 2013 and PsychINFO for articles up to July 2013, using the keywords "cortisol" and "stroke" and associated terms or synonyms. We included studies published in peer-reviewed journals that recruited 10 or more participants and measured cortisol at least once in the first year following stroke. Data were extracted regarding cortisol levels, including changes over time and their relationship to stroke severity, and outcome. Of 11,240 abstracts, 101 full texts were obtained and 48 fulfilled our inclusion criteria. Cortisol levels were high in the first week after stroke in the majority of studies (26 studies, n = 1,340). Higher cortisol was associated with dependency (8/11 studies, n = 822), delirium (5/6 studies, n = 269) depression (3/5 studies n = 117) and mortality (8/10 studies, n = 856). Five studies adjusted for stroke severity; one found an association between higher cortisol and dependency, and three found an association between higher cortisol and mortality. Cortisol levels are high for at least 7 days after stroke. Elevated cortisol after stroke is associated with dependency, morbidity, and mortality; however, there is insufficient evidence to conclude that these relationships are independent of stroke severity.
研究表明，下丘脑-垂体-肾上腺轴功能失调与非中风患者的发病率和死亡率之间存在关联。我们进行了一项系统评价，以评估急性中风患者的皮质醇水平及其与预后的关系。我们检索了 MEDLINE 和 EMBASE 截至 2013 年 4 月的文献，以及 PsychINFO 截至 2013 年 7 月的文献，使用的关键词是“皮质醇”和“中风”以及相关术语或同义词。我们纳入了发表在同行评议期刊上的研究，这些研究招募了 10 名或以上参与者，并在中风后至少 1 年内测量了皮质醇。提取的数据包括皮质醇水平，包括随时间的变化及其与中风严重程度和预后的关系。在 11240 篇摘要中，有 101 篇全文被获取，其中 48 篇符合我们的纳入标准。在大多数研究中（26 项研究，n = 1340），中风后第一周皮质醇水平较高。较高的皮质醇与依赖性（8/11 项研究，n = 822）、谵妄（5/6 项研究，n = 269）、抑郁（3/5 项研究，n = 117）和死亡率（8/10 项研究，n = 856）相关。有 5 项研究调整了中风严重程度；其中一项研究发现皮质醇水平与依赖性之间存在关联，三项研究发现皮质醇水平与死亡率之间存在关联。中风后皮质醇水平至少持续 7 天升高。中风后皮质醇升高与依赖性、发病率和死亡率有关；然而，目前尚无足够证据可以得出结论，认为这些关系与中风严重程度无关。
