亚临床甲状腺功能减退症与大动脉粥样硬化性卒中患者脑血管动脉粥样硬化程度的相关性

目的 探讨亚临床甲状腺功能减退症(subclinical hypothyroidism,SCH)与大动脉粥样硬化卒中患者脑动脉粥样硬化负荷的相关性.方法 纳入连续住院的急性大动脉粥样硬化性卒中患者.SCH定义为血清促甲状腺激素(thyroid stimulating hormone,TSH) 4.50~10.0 mU/L且血清甲状腺素水平正常.应用脑动脉粥样硬化负荷评分评价脑动脉粥样硬化严重程度,总分1~2分定义为轻度动脉粥样硬化,>2分定义为重度动脉粥样硬化.采用单变量分析和多变量logistic回归分析评价SCH与重度脑动脉粥样硬化的相关性.结果 共纳入263例急性大动脉粥样硬化性卒中患者,其中SCH 62例(23.6%),轻度动脉粥样硬化119例(45.2%),重度动脉粥样硬化144例(54.8%).重度脑动脉粥样硬化组年龄[(63.6±10.9)岁对(60.5±11.4)岁;t=2.274,P=0.024]、高半胱氨酸水平[(17.10±6.20)μmol/L对(15.63±5.17)μmol/L;t=2.058,P=0.041]、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分[8.0(5.0~10.0)分对6.0(5.0~9.0)分;Z=2.059,P=0.039]以及高血压(72.9%对58.8%;χ2=5.812,P=0.016)、吸烟(38.2%对26.1%;χ2=4.366,P=0.037)和SCH(30.6%对15.1%;χ2=8.610,P=0.003)患者的构成比均显著高于轻度脑动脉粥样硬化组.多变量logistic回归分析显示,在校正年龄、性别、高血压、吸烟、高半胱氨酸水平以及NIHSS评分后,SCH是大动脉粥样硬化性卒中患者存在重度动脉粥样硬化的独立危险因素(优势比3.345,95%可信区间1.692~6.612;P=0.001).结论 SCH是大动脉粥样硬化性卒中患者存在重度脑动脉粥样硬化的独立危险因素.

Correlation between subclinical hypothyroidism and degree of cerebral atherosclerosis in patients with large artery atherosclerotic stroke

Objective To investigate the correlation between subclinical hypothyroidism (SCH) and cerebral atherosclerosis burden in patients with large artery atherosclerotic stroke.Methods Consecutive inpatients with acute large artery atherosclerotic stroke were enrolled.SCH was defined as TSH 4.50-10.0 mU/L and serum thyroxine level was normal.Cerebral atherosclerosis burden score was used to evaluate the severity of cerebral atherosclerosis.The total score of 1 or 2 was defined as mild atherosclerosis,and >2 was defined as severe atherosclerosis.Univariate analysis and multivariate logistic regression analysis was used to evaluate the correlation between SCH and severe cerebral atherosclerosis.Results A total of 263 patients with large artery atherosclerotic stroke were enrolled,including SCH 62 (23.6%),mild atherosclerosis 119 (45.2%),and severe atherosclerosis 144 (54.8%).The age (63.6±10.9 years vs.60.5±11.4 years;t=2.274,P=0.024),homocysteine (17.10±6.20 μmol/L vs.15.63±5.17 μmol/L;t=2.058,P=0.041),National Institutes of Health Stroke Scale (NIHSS) score (8.0 [5.0-10.0]vs.6.0 [5.0-9.0];Z=2.059,P=0.039),as well as the proportions of patients with hypertension (72.9%vs.58.8%;χ2=5.812,P=0.016),smoking (38.2%vs.26.1%;χ2=4.366,P=0.037),and SCH (30.6%vs.15.1%;χ2=8.610,P=0.003) in the severe cerebral atherosclerosis group were significantly higher than those in the mild cerebral atherosclerosis group.Multivariate logistic regression analysis indicated that SCH was an independent risk factor for severe atherosclerosis in patients with large atherosclerotic stroke (odd ratio 3.345;95%confidence interval 1.692-6.612;P=0.001) after adjusting for age,sex,hypertension,smoking,homocysteine,and NIHSS score.Conclusion SCH is an independent risk factor for severe cerebral atherosclerosis in patients with large atherosclerotic stroke.