Department of Neurosurgery and Spine, Surgery University Hospital of Essen, 45147, Essen, Germany.
Department of Neurosurgery and Spine Surgery, Evangelisches Krankenhaus Oldenburg, Essen, Germany.
Acta Neurochir (Wien). 2024 Jun 3;166(1):245. doi: 10.1007/s00701-024-06118-7.
Thyroid hormones were reported to exert neuroprotective effects after ischemic stroke by reducing the burden of brain injury and promoting post-ischemic brain remodeling.
We aimed to analyze the value of thyroid hormone replacement therapy (THRT) due to pre-existing hypothyroidism on the clinical course and outcome of aneurysmal subarachnoid hemorrhage (SAH).
SAH individuals treated between January 2003 and June 2016 were included. Data on baseline characteristics of patients and SAH, adverse events and functional outcome of SAH were recorded. Study endpoints were cerebral infarction, in-hospital mortality and unfavorable outcome at 6 months. Associations were adjusted for outcome-relevant confounders.
109 (11%) of 995 individuals had THRT before SAH. Risk of intracranial pressure- or vasospasm-related cerebrovascular events was inversely associated with presence of THRT (p = 0.047). In multivariate analysis, THRT was independently associated with lower risk of cerebral infarction (adjusted odds ratio [aOR] = 0.64, 95% confidence interval [CI] = 0.41-0.99, p = 0.045) and unfavorable outcome (aOR = 0.50, 95% CI = 0.28-0.89, p = 0.018), but not with in-hospital mortality (aOR = 0.69, 95% CI = 0.38-1.26, p = 0.227).
SAH patients with THRT show lower burden of ischemia-relevant cerebrovascular events and more favorable outcome. Further experimental and clinical studies are required to confirm our results and elaborate the mechanistic background of the effect of THRT on course and outcome of SAH.
甲状腺激素通过减轻脑损伤负担和促进缺血后脑重塑，据报道可发挥神经保护作用，从而减轻缺血性脑卒中后的脑损伤。
我们旨在分析由于既往存在甲状腺功能减退症而进行甲状腺激素替代治疗（THRT）对蛛网膜下腔出血（SAH）患者临床病程和结局的价值。
纳入 2003 年 1 月至 2016 年 6 月期间治疗的 SAH 患者。记录患者基线特征、SAH 情况、不良事件和 SAH 功能结局数据。研究终点为脑梗死、住院期间死亡率和 6 个月时不良结局。对与结局相关的混杂因素进行调整。
995 例患者中 109 例（11%）在发生 SAH 前有 THRT。颅内压或血管痉挛相关脑血管事件的风险与 THRT 的存在呈负相关（p=0.047）。多变量分析表明，THRT 与脑梗死风险降低独立相关（调整优势比[aOR]=0.64，95%置信区间[CI]=0.41-0.99，p=0.045）和结局不良（aOR=0.50，95% CI=0.28-0.89，p=0.018）相关，但与住院期间死亡率无关（aOR=0.69，95% CI=0.38-1.26，p=0.227）。
THRT 的 SAH 患者缺血相关脑血管事件负担较低，结局较好。需要进一步的实验和临床研究来证实我们的结果，并阐述 THRT 对 SAH 病程和结局的影响的机制背景。
