急性脑血管病患者血清促甲状腺激素变化的临床分析

目的 探讨急性脑血管病(acute cerebrovascular disease, ACVD)患者血清促甲状腺激素(thyroid stimulating hormone, TSH)的变化及其临床意义。方法 收集住院ACVD患者155例,根据病情及愈后分组。检测TSH及其他甲状腺激素,并与55例健康体检者比较。并初步分析TSH判断ACVD病情程度及愈后的受试者工作特征(ROC)曲线下面积、最佳临界值、敏感性及特异性。结果 与对照组比较,ACVD组TSH升高,差异有统计学意义(1.34±0.36 vs 1.17±0.94μIU/ml, P＜0.05)；TSH随病情加重明显升高,轻型组、中型组、重型组分别为1.01±0.43μIU/ml,2.11±1.73μIU/ml,2.82±1.06μIU/ml(P＜0.05),TSH判断病情程度的ROC曲线下面积为0.941(与0.5相比,P＜0.01),最佳临界值为1.89mIU/L,敏感性为100％,特异性为88.4％；愈后越差TSH越高,基本痊愈组、进步组和无变化组分别为0.94±0.44μIU/ml,2.71±1.15μIU/ml,3.47±1.61μIU/ml(P＜0.05),TSH判断愈后的ROC曲线下面积为0.716(与0.5相比,P＜0.01),最佳临界值为1.30mIU/L,敏感性为60.0％,特异性为77.0％。结论 ACVD急性期血清TSH水平升高,将影响甲状腺功能的正确评估,应在急性期后予复查,以免作出不恰当干预。TSH水平与病情轻重及愈后具有相关性。
Objective To investigate serum thyroid stimulating hormone (TSH) levels in patients with acute cerebrovascular diseases (ACVD) and its clinical significance. MethodsOne hundred and fifty five patients with ACVD admitted from January 2013 to June 2014 were enrolled. Serum TSH levels and other thyroid hormones were examined and compared with healthy control individuals. The area under curve (AUC) of Receiver Operating Characteristic (ROC), the optimist threshold, sensitivity and specificity of TSH in determining of severity and prognosis with ACVD was analyzed. ResultsCompared with control group,serum TSH levels in ACVD group were significantly higher (1.34±0.36v.s.1.17±0.94μIU/ml, P＜0.05). Compared with mild ACVD group(1.01±0.43μIU/ml)serum TSH levels in intermediate(2.11±1.73μIU/ml)and severe ACVD groups (2.82±1.06μIU/ml) were significantly higher (P＜0.05). The AUC of TSH for severe ACVD patients was 0.941; with the optimal threshold of 1.89μIU/ml, the sensitivity and specificity of TSH in determining of the sever ACVD were 100.0％and 88.4％,respectively. Compared with patients with cured disease(0.94±0.44μIU/ml), serum TSH levels in patients with improved disease (2.71±1.15μIU/ml)and with unchanged disease(3.47±1.61μIU/ml) were significantly higher (P＜0.05). The AUC for predicting poor prognosis was 0.716; with the optimal threshold of 1.30μIU/ml, the sensitivity and specificity of TSH in predicting poor ACVD prognosis were 60.0％and 77.0％,respectively. ConclusionTSH levels are higher in patients with ACVD,which may affect the evaluation of thyroid function, suggesting that serum TSH should be measured after the acute phase of ACVD. High serum TSH levels are associated with the severity and poor prognosis of ACVD