| 刘长福,孙蓓,宋懿红,等.血清甲状腺激素水平预测老年缺血性脑卒中后癫痫发作的价值[J].安徽医药,2026,30(2):334-341. |
| 血清甲状腺激素水平预测老年缺血性脑卒中后癫痫发作的价值 |
| The value of serum thyroid hormones' levels in predicting post-ischemic stroke seizures in the elderly |
| |
| DOI：10.3969/j.issn.1009-6469.2026.02.024 |
| 中文关键词: 脑梗死 卒中 癫痫 甲状腺激素 癫痫发作 缺血性脑卒中后癫痫 |
| 英文关键词: Brain infarction Stroke Epilepsy Thyroid hormones Seizure Post-ischemic stroke seizure |
| 基金项目: |
|
| 摘要点击次数: 390 |
| 全文下载次数: 880 |
| 中文摘要: |
| 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，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)癫评分［6(3，9)分比 2(1，4)分］梗死体积［ 15.53(9.84，32.82)cm3比 1.62(0.42，7.24)cm3］、血，清 FT3［5.14(4.64，5.50)pmol/L比 4.53(4.17，4.91)pmol/L］、神经元性烯醇化酶( 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 |
| 英文摘要: |
| 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 tothe Affiliated Lianyungang Hospital of Xuzhou Medical University from January 2020 to December 2022. All patients underwent a stan-dardized regimen of clinical treatment. Their gender, age, and medical history were meticulously recorded. Additionally, laboratory testresults, including serum free triiodothyronine (FT3), free tetraiodothyronine (FT4), and thyroid stimulating hormone (TSH), as well asimaging features such as infarct site and infarct volume, were also recorded. Subsequently, the patients were regularly followed up. Thepatients 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 anal-ysis results were incorporated as independent variables into a multivariate logistic regression analysis model to evaluate whether serumTHs levels are risk factors for PISS. The receiver operating characteristic curve(ROC curve) and the area under curve (AUC) were uti-lized to evaluate the predictive value of serum THs levels for PISS.Results In this study, 898 elderly patients with ischemic strokewere 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)], in-farct volume [15.53 (9.84, 32.82)cm3 vs. 1.62 (0.42,7.24)cm3], FT3 [5.14 (4.64, 5.50)pmol/L vs. 4.53 (4.17, 4.91)pmol/L], and neuron-specific 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 is0.76, the optimal cutoff value was 4.91 pmol/L, the sensitivity was 72.84%,and the specificity was 75.03%.The ROC curve showed thatthe predictive value of infarct location,serum FT3 combined with X11 and X14 for PISS was better than that of using serum FT3 aloneand 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. |
|
查看全文
查看/发表评论 下载PDF阅读器 |
| 关闭 |
|
|
|
