Lee Sang-Hwa, Jang Min Uk, Kim Yerim, Park So Young, Kim Chulho, Kim Yeo Jin, Sohn Jong-Hee
Department of Neurology, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, South Korea.
Department of Neurology, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, South Korea.
Front Neurol. 2019 Jul 17;10:782. doi: 10.3389/fneur.2019.00782. eCollection 2019.
Evidence for the effect of subclinical thyroid dysfunction on the prognosis of patients suffering from acute ischemic stroke and receiving reperfusion therapy remains controversial. We aimed to investigate the association between subclinical thyroid dysfunction and the outcomes of patients with acute ischemic stroke who were treated with reperfusion therapy. One hundred fifty-six consecutively recruited patients with acute ischemic stroke receiving reperfusion therapy (intravenous thrombolysis, intraarterial thrombectomy and combined intravenous thrombolysis and intraarterial thrombectomy) were included in this prospective observational study. We divided patients with subclinical thyroid dysfunction into the following 2 groups and defined a euthyroid group: subclinical hyperthyroidism (a thyroid-stimulating hormone level <0.35 μU/mL), subclinical hypothyroidism (a thyroid-stimulating hormone level >4.94 μU/mL), and a euthyroid state (0.35 μU/mL ≤ thyroid-stimulating hormone level ≤ 4.94 μU/mL). Patients with overt thyroid dysfunction were excluded. The primary outcome was functional disability at 3 months (modified Rankin Scale, mRS), and the secondary outcome was successful reperfusion. A multivariate analysis was performed to evaluate the associations between subclinical thyroid dysfunction and the primary and secondary outcomes. The subclinical hyperthyroidism group appeared to have poor functional outcomes, but the differences were not significant. However, compared with patients in the euthyroid state, patients with subclinical hyperthyroidism had an increased risk of poor functional outcomes at 3 months after a stroke (adjusted odds ratio [OR] 2.50, 95% confidence interval [CI] 1.01-6.14 for a mRS score of 3 to 6) and a decreased rate of successful reperfusion after reperfusion therapy (OR 0.13, 95% CI 0.04-0.43). Subclinical hyperthyroidism may be independently associated with a poor prognosis at 3 months and unsuccessful reperfusion in patients with acute ischemic stroke receiving reperfusion therapy.
亚临床甲状腺功能障碍对接受再灌注治疗的急性缺血性脑卒中患者预后的影响，相关证据仍存在争议。我们旨在研究亚临床甲状腺功能障碍与接受再灌注治疗的急性缺血性脑卒中患者预后之间的关联。本前瞻性观察性研究纳入了156例连续招募的接受再灌注治疗（静脉溶栓、动脉内血栓切除术以及静脉溶栓联合动脉内血栓切除术）的急性缺血性脑卒中患者。我们将亚临床甲状腺功能障碍患者分为以下两组，并定义了一个甲状腺功能正常组：亚临床甲状腺功能亢进（促甲状腺激素水平<0.35 μU/mL）、亚临床甲状腺功能减退（促甲状腺激素水平>4.94 μU/mL）以及甲状腺功能正常状态（0.35 μU/mL≤促甲状腺激素水平≤4.94 μU/mL）。排除明显甲状腺功能障碍的患者。主要结局为3个月时的功能残疾（改良Rankin量表，mRS），次要结局为再灌注成功。进行多因素分析以评估亚临床甲状腺功能障碍与主要和次要结局之间的关联。亚临床甲状腺功能亢进组似乎功能结局较差，但差异无统计学意义。然而，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在卒中后3个月出现功能结局不良的风险增加（mRS评分为3至6时，调整后的比值比[OR]为2.50，95%置信区间[CI]为1.01 - 6.14），且再灌注治疗后再灌注成功的比例降低（OR为0.13，95% CI为0.04 - 0.43）。亚临床甲状腺功能亢进可能与接受再灌注治疗的急性缺血性脑卒中患者3个月时的不良预后和再灌注失败独立相关。
