摘要
目的探讨血清甲状腺激素(THs)水平预测老年缺血性脑卒中后癫痫发作(PISS)的价值。方法回顾性分析2020年1月至2022年12月于徐州医科大学附属连云港医院收治的急性老年缺血性脑卒中病人898例,所有病人均经过临床规范化治疗,记录病人的性别、年龄、既往史、血清游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)、促甲状腺激素(TSH)等检验结果、梗死部位及梗死体积等影像学特征,根据随访期间是否出现癫痫发作,分为癫痫组(n=81)和非癫痫组(n=817)。分析两组临床资料,将单因素分析结果中P<0.50的变量作为自变量纳入多因素logistic回归分析模型,分析血清THs水平是否是PISS的危险因素,使用受试者操作特征曲线(ROC曲线)及曲线下面积(AUC)评估血清THs水平对PISS的预测价值。结果898例老年缺血性脑卒中病人,有81例发生癫痫发作,其中20例于发病1周内出现,61例于1周后出现。与非癫痫组比较,癫痫组颈动脉系统梗死(97.5%比79.1%)、皮质梗死比例(80.2%比43.2%)较高(P<0.01),美国国立卫生研究院卒中量表(NIHSS)评分[6(3,9)分比2(1,4)分]、梗死体积[15.53(9.84,32.82)cm^(3)比1.62(0.42,7.24)cm^(3)]、血清FT3[5.14(4.64,5.50)pmol/L比4.53(4.17,4.91)pmol/L]、神经元特异性烯醇化酶(NSE)[15.38(11.92,20.21)μg/L比12.34(7.06,16.41)μg/L]、甘油三酯(TG)[1.68(1.12,2.11)mmol/L比1.27(0.92,1.82)mmol/L]水平较高(P<0.01)。多因素logistic回归分析显示,梗死部位(皮质)[OR=5.08,95%CI:(2.74,9.43)]、血清FT3[OR=3.91,95%CI:(2.63,5.82)]、梗死体积与NSE的交叉积(X11)[OR=1.00,95%CI:(1.00,1.00)]、入院时NIHSS评分与NSE的交叉积(X14)[OR=1.01,95%CI:(1.00,1.01)]是PISS的独立危险因素。AUC分析结果显示,血清FT3水平预测PISS的AUC为0.76,最佳截断值为4.91 pmol/L,灵敏度为72.84%,特异度为75.03%。ROC曲线显示,梗死部位、血清FT3联合X11、X14对PISS的预测价值优于单独使用血清FT3的预测价值,也优于梗死部位的预测价值。结论血清FT3水平是PISS的独立危险因素,检测FT3水平有助于预测PISS的风险。梗死部位、血清FT3水平联合X11、X14对PISS的预测效果优于单独使用血清FT3。这一发现也为老年PISS的预防提供了新的思路。
Objective To investigate the value of serum thyroid hormones(THs)'levels in predicting post-ischemic stroke seizures(PISS)in the elderly.Methods A retrospective analysis was conducted on 898 elderly patients with acute ischemic stroke admitted to the Affiliated Lianyungang Hospital of Xuzhou Medical University from January 2020 to December 2022.All patients underwent a standardized regimen of clinical treatment.Their gender,age,and medical history were meticulously recorded.Additionally,laboratory test results,including serum free triiodothyronine(FT3),free tetraiodothyronine(FT4),and thyroid stimulating hormone(TSH),as well as imaging features such as infarct site and infarct volume,were also recorded.Subsequently,the patients were regularly followed up.The patients were divided into epilepsy group(n=81)and non-epilepsy group(n=817)according to whether there was a seizure during the follow-up period.The clinical data of both groups were then analyzed.The variables with a P-value less than 0.50 in the univariate analysis results were incorporated as independent variables into a multivariate logistic regression analysis model to evaluate whether serum THs levels are risk factors for PISS.The receiver operating characteristic curve(ROC curve)and the area under curve(AUC)were utilized to evaluate the predictive value of serum THs levels for PISS.Results In this study,898 elderly patients with ischemic stroke were included.Seizures occurred in 81 cases,of which 20 cases occurred within 1 week after onset and 61 cases occurred after 1 week.Compared with the non-epilepsy group,the epilepsy group had a higher proportion of carotid artery system infarction(97.5%vs.79.1%)and cortical infarction(80.2%vs.43.2%)(P<0.01).The National Institutes of Health Stroke Scale(NIHSS)score[6(3,9)vs.2(1,4)],infarct volume[15.53(9.84,32.82)cm^(3) vs.1.62(0.42,7.24)cm^(3)],FT3[5.14(4.64,5.50)pmol/L vs.4.53(4.17,4.91)pmol/L],and neuronspecific enolase(NSE)[15.38(11.92,20.21)μg/L vs.12.34(7.06,16.41)μg/L],and triglyceride levels[1.68(1.12,2.11)mmol/L vs.1.27(0.92,1.82)mmol/L]were significantly higher(P<0.01).Multivariate logistic regression analysis showed that the infarct location(cortex)[OR=5.08,95%CI:(2.74,9.43)],serum FT3[OR=3.91,95%CI:(2.63,5.82)],the cross product of infarct volume and NSE(X11)[OR=1.00,95%CI:(1.00,1.00)],and the cross product of admission NIHSS score and NSE(X14)[OR=1.01,95%CI:(1.00,1.01)]were independent risk factors for PISS.The results of AUC analysis show that the AUC for predicting post-ischemic stroke seizures by serum FT3 level is 0.76,the optimal cutoff value was 4.91 pmol/L,the sensitivity was 72.84%,and the specificity was 75.03%.The ROC curve showed that the predictive value of infarct location,serum FT3 combined with X11 and X14 for PISS was better than that of using serum FT3 alone and also better than that of infarct location alone.Conclusions Serum FT3 level is an independent risk factor for PISS.Detecting the FT3 level is helpful for predicting the risk of PISS.The predictive effect of the combination of infarct location,serum FT3 level,X11,and X14 on PISS is better than that of serum FT3 alone.These findings also provide new ideas for the prevention of PISS in the elderly.
作者
刘长福
孙蓓
宋懿红
庄一夫
张永进
张广慧
LIU Changfu;SUN Bei;SONG Yihong;ZHUANG Yifu;ZHANG Yongjin;ZHANG Guanghui(Department of Neurology,The Affiliated Lianyungang Hospital of Xuzhou Medical University,Lianyungang,Jiangsu 222023,China)
出处
《安徽医药》
2026年第2期334-341,共8页
Anhui Medical and Pharmaceutical Journal
