CAJ | 학술논문

目的探讨伴低T3综合征的脑梗死患者预后较不伴者更差的原因. 方法选择南京医科大学附属苏州医院神经内科自2010年1月至2012年12月收治的162例脑梗死患者为研究对象,采用放射免疫学方法测定患者三碘甲腺原氨酸(T3)、四碘甲腺原氨酸(T4)、促甲状腺激素(TSH)、游离三碘甲腺原氨酸(fT3)、游离四碘甲腺原氨酸(fT4)水平,根据头颅MRI、MRA或CTA、颈动脉彩超等检查结果确定脑梗死灶定位[颈内动脉系统(ICA)或椎基底动脉系统(VBA)]及TOAST分型,应用美国国立卫生研究院卒中量表评分(NIHSS)评估患者病情最严重时的神经功能. 结果 (1)162例脑梗死患者中,29例(17.90％)伴低T3综合征(低T3综合征组),20例(12.35％)fT3水平低于正常下限(2.63 pmol/L),T4、fT4、TSH水平均在正常范围.(2)低T3综合征组的T3、fT3、TSH水平均明显低于对照组,差异均有统计学意义(P＜0.05).(3)TOAST分型各亚型在低T3综合征组与对照组中的分布比比较差异无统计学意义(P＞0.05).(4)伴低T3综合征的大动脉粥样硬化型ICA梗死患者的NIHSS峰值评分明显高于不伴低T3综合征的患者,差异有统计学意义(P＜0.05). 结论伴低T3综合征的大动脉粥样硬化型ICA梗死患者神经功能缺损更严重,可能是其预后更差的原因.
목적 탐토반저T3종합정적뇌경사환자예후교불반자경차적원인. 방법 선택남경의과대학부속소주의원신경내과자2010년1월지2012년12월수치적162례뇌경사환자위연구대상,채용방사면역학방법측정환자삼전갑선원안산(T3)、사전갑선원안산(T4)、촉갑상선격소(TSH)、유리삼전갑선원안산(fT3)、유리사전갑선원안산(fT4)수평,근거두로MRI、MRA혹CTA、경동맥채초등검사결과학정뇌경사조정위[경내동맥계통(ICA)혹추기저동맥계통(VBA)]급TOAST분형,응용미국국립위생연구원졸중량표평분(NIHSS)평고환자병정최엄중시적신경공능. 결과 (1)162례뇌경사환자중,29례(17.90％)반저T3종합정(저T3종합정조),20례(12.35％)fT3수평저우정상하한(2.63 pmol/L),T4、fT4、TSH수평균재정상범위.(2)저T3종합정조적T3、fT3、TSH수평균명현저우대조조,차이균유통계학의의(P＜0.05).(3)TOAST분형각아형재저T3종합정조여대조조중적분포비비교차이무통계학의의(P＞0.05).(4)반저T3종합정적대동맥죽양경화형ICA경사환자적NIHSS봉치평분명현고우불반저T3종합정적환자,차이유통계학의의(P＜0.05). 결론 반저T3종합정적대동맥죽양경화형ICA경사환자신경공능결손경엄중,가능시기예후경차적원인.
Objective To explore the mechanism underlying the poor prognosis in cerebral infarction (CI) patients with low T3 syndrome by comparing the NIHSS scores in these patients with or without low T3 syndrome.Methods One hundred and sixty-two patients with CI,admitted to our hospital from January 2010 to December 2012,were chosen in our study; the levels of thyroid hormones,including triiodothyronine (T3),four iodine thyronine (T4),thyroid stimulating hormone (TSH),free Triiodothyronine (iT3) and free four iodine thyronine (fT4),were measured by radioimmunoassay.CI lesions and TOAST distribution were determined by cranial MRI,magnetic resonance angiography (MRA) or CT angiography (CTA),and carotid ultrasonography.NIHSS scores at the worst in cerebral infarction inpatients were detected.Results In the 162 patients with CI,29 patients (17.90％) were combined with low T3 symptom and 20 had fT3 level lower than the lowest normal level (2.63 pmol/L); and T4,fT4 and TSH levels were within normal limits.T3,fr3 and TSH levels in patients with low T3 symptom were significantly lower than those of patients without low T3 symptom (P＜0.05).The distribution of TOAST showed no significant difference between patients with low T3 symptom and patients without low T3 symptom (P＞0.05).In patients with large artery atherosclerosis-internal carotid artery,the NIHSS scores at the worst in patients with low T3 level were significantly higher as compared with those in patients with normal T3 levels (P＜0.05).Conclusion The neurologic impairment is more severe in large artery atherosclerosis-intemal carotid artery patients with low T3 level than those without low T3 level,which might be responsible for the poor prognosis of the illness with low T3 syndrome.