Stroke：亚临床甲亢为卒中后功能转归不佳危险因素

德国学者的一项研究表明，亚临床甲状腺功能亢进（简称亚临床甲亢）为缺血性卒中后功能转归不佳的危险因素。论文于2013年3月12日在线发表于《卒中》（Stroke）。
　　此项前瞻性观察研究共纳入165例缺血性卒中患者。在发病3天内于清晨采集血液样本。依据促甲状腺素水平将患者分别为亚临床甲亢（0.1<促甲状腺素≤0.44 μU/mL）、亚临床甲减（2.5≤促甲状腺素<20 μU/mL）和甲状腺功能正常（0.44<促甲状腺素<2.5 μU/mL）。伴有明显甲状腺功能障碍的患者被排除在外。在卒中3个月后启动随访。主要转归为功能残疾（改良Rankin量表），次要转归为依赖水平（Barthel指数）。利用Logistic回归分析对房颤、总胆固醇和BMI等潜在混淆因素加以校正。
　　结果显示，亚临床甲亢和甲减患者分别为19例（11.5%）和23例（13.9%）。对年龄、性别、吸烟状况和采样时间进行校正之后，与甲状腺功能正常者相比，亚临床甲亢患者的卒中3个月后功能残疾风险显著升高（比值比[OR] 2.63）。以基线NIHSS、TIA、血清CRP、房颤、BMI和总胆固醇作为附加变量时，上述相关性依然显著（OR 3.95），并且可通过次要转归加以确认。
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Subclinical Hyperthyroidism Is a Risk Factor for Poor Functional Outcome After Ischemic Stroke
Background and Purpose
Subclinical hyperthyroidism is associated with adverse cardiovascular events, including stroke and atrial fibrillation. However, its impact on functional outcome after stroke remains unexplored.
Methods
A total of 165 consecutively recruited patients admitted for ischemic stroke were included in this observational prospective study. Blood samples were taken in the morning within 3 days after symptom onset, and patients were divided into the following 3 groups: subclinical hyperthyroidism (0.1< thyroid-stimulating hormone ≤0.44 μU/mL), subclinical hypothyroidism (2.5≤ thyroid-stimulating hormone <20 μU/mL), and euthyroid state (0.44< thyroid-stimulating hormone <2.5 μU/mL). Patients with overt thyroid dysfunction were excluded. Follow-up took place 3 months after stroke. Primary outcome was functional disability (modified Rankin Scale), and secondary outcome was level of dependency (Barthel Index). Ordinal logistic regression analysis was used to adjust for possible confounders. Variables previously reported to be affected by thyroid function, such as atrial fibrillation, total cholesterol, or body mass index, were included in an additional model.
Results
Nineteen patients (11.5%) had subclinical hyperthyroidism, and 23 patients (13.9%) had subclinical hypothyroidism. Patients with subclinical hyperthyroidism had a substantially increased risk of functional disability 3 months after stroke compared with subjects with euthyroid state (odds ratio, 2.63; 95% confidence interval, 1.02–6.82, adjusted for age, sex, smoking status, and time of blood sampling). The association remained significant, when including the baseline NIHSS, TIA, serum CRP, atrial fibrillation, body mass index, and total cholesterol as additional variables (odds ratio, 3.95; 95% confidence interval, 1.25–12.47), and was confirmed by the secondary outcome (Barthel Index: odds ratio, 9.12; 95% confidence interval, 2.08–39.89).
Conclusions
Subclinical hyperthyroidism is a risk factor for poor outcome 3 months after ischemic stroke.