低T3综合征及GCS评分与高血压脑出血生存率及再出血的关系研究被引量：34

Associations of low triiodothyronine syndrome and Glasgow coma scale scores with mortalities and recurrence in hypertensive intracerebral hemorrhage

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摘要目的探讨低T3综合征及GCS评分与高血压脑出血生存率及再出血的关系。方法收集自2015年1月至2016年1月就诊于咸阳市第一人民医院神经外一科并确诊为高血压脑出血的患者230例纳入研究，对所有患者进行甲状腺功能的测定[包括游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）及促甲状腺激素（TSH）3项指标]。根据检测结果将患者分为低T3组（FT3〈3．1pmol／L，TSH正常）以及甲状腺功能正常组（FT3、FT4、TSH均正常）。根据受试者工作特征曲线（ROC）确定的最佳界值将患者分为低GCS组（GCS≤7．5）和高GCS组（GCS〉7．5），以及低T3组（FT3≤2．85pmol／L）和高T3组（FT3〉2．85pmol／L）。每6个月电话随访1次，以随访期内死亡或再出血为终点事件，通过ROC确定GCS评分及FT3水平预测随访期内死亡率及再出血率的价值。绘制Kaplan—Meier图进行生存分析并比较各组患者生存率，采用多因素Cox回归分析不同GCS评分及FT3水平与死亡及再出血发生率之间的关系。结果低T3组（FT3〈3．1pmol／L）与正常组（FT3、FT4、TSH均正常）相比，平均年龄较高，丘脑出血率较高，出血量〉30mL者比例较高，破人脑室发生率较高，人院时CGS评分较低，FT3水平较低，差异均有统计学意义（P〈0．05）。ROC显示GCS评分预测随访期内死亡率及再出血的灵敏度为63％，特异度为73％；FT3水平预测的灵敏度为45％，特异度为73％。Kaplan-Meier曲线显示低GCS组的死亡率和再出血率明显高于高GCS组,而低T3组的死亡率和再出血率明显高于高T3组，差异均有统计学意义（P〈0．05）。联合预测结果显示低GCS＋低T3组的死亡率及再出血发生率均明显高于其他3组，差异有统计学意义（P〈0．05）。结论低T3综合征在高血压脑出血中较常见，FT3水平和GCS评分的联合测定在高血压脑出血的预后判断中有重要价值。 Objective Both free triiodothyronine （FT3） level and Glasgow Coma scale （GCS） scores have been separately described as prognostic predictors for mortality in hypertensive intracerebral hemorrhage （HICH）. This study is conducted to investigate the relationship and prognostic impact of low-T3 syndrome and GCS in HICH patients. Methods Two hundred and thirty patients with HICH, admitted to our hospital from January 2015 to January 2016, were chosen and performed thyroid hormone levels examination （FT3, FT4 and thyroid stimulating hormone [TSH] 3）. According to the thyroid hormone results, these patients were divided into low T3 group I （FT3〈3.1 pmol/L, normal TSH level） and normal thyroid function group （normal FT3, FT4 and TSH levels）. According to best cut-off levels defined by receiver operating characteristic （ROC） curve, these patients were divided into low GCS scores group （GCS ≤7.5） and high GCS scores group （GCS〉7.5）, and low T3 group II （FT3〈2.85 pmol/L） and high T3 group （FT3〉2.85 pmol/L）. Telephone follow-up was performed every 6 months, and using death or re-bleeding during follow-up period as end point of the event, prognostic values of FT3 level and GCS scores defined by ROC curve in mortality and re-bleeding rate were recorded; survival rate of these patients were analyzed by Kaplan-Meier curves and compared between each two groups; multivariate Cox regression was used to analyze the relations of FT3 level and GCS scores with mortality and re-bleeding rate. Results As compared with normal thyroid ftmction group, low T3 group I had significantly higher re-bleeding rate, percentage of patients with blood loss〉30 mL, and rate of breaking into the ventricles, and statistically lower GCS scores at admission and FT3 level （P〈0.05）; the mean age in patients of low T3 group I was significantly elder than that in patients of normal thyroid function group （P〈0.05）. ROC results indicated that the sensitivity and specificity of GCS scores in predicting mortality and re-bleeding rate were 63% and 73%, and those of FT3 level were 45% and 73%. Kaplan-Meier curves showed that both low GCS group and low T3 group II had significantly increased mortality and re-bleeding rate as compared with high GCS group and high T3 group （P〈0.05）. Unified prediction results indicated that patients from low T3 and low GCS group had significantly higher mortality and re-bleeding rate as compared with patients from low T3 and high GCS group, high T3 and low GCS group, and high T3 and high GCS group （P〈0.05）. Conclusion Low T3 syndrome is common in patients with HICH; FT3 level and GCS scores appear to be important predictors for mortality and recurrence in patients with HICH.

作者王国飞康眼训蔡甜甜许建坤徐宣乐赵悦车鹏王宏利赵虎威段飞 Wang Guofei;Kang Yanxun;Cai Tiantian;Xu Jiankun;Xu Xuanle;Zhao Yue;Cite Peng;Wang Hongli;Zhao Huwei;Duan Fei(Department of Neurosurgery,First People＇s Hospital of Xianyang,Xianyang 712000,China;CT Room,First People＇s Hospital of Xianyang,Xianyang 712000,China;Unite One,Department of Endocrine,First People＇s Hospital of Xianyang,Xianyang 712000,Chin;Department of Neurosurgery,Qixian People＇s Hospital of Shanxi Province,Qixian 030900,Chin)

机构地区咸阳市第一人民医院神经外一科咸阳市第一人民医院CT室咸阳市第一人民医院内分泌一科山西省祁县人民医院神经外科

出处《中华神经医学杂志》 CAS CSCD 北大核心 2018年第7期699-704,共6页 Chinese Journal of Neuromedicine

关键词高血压脑出血格拉斯哥昏迷评分游离三碘甲状腺原氨酸预后 Hypertensive intracerebral hemorrhage Glasgow coma scale Free triiodothyronine Prognosis

分类号 R743.2 [医药卫生—神经病学与精神病学]

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