急性脑血管病患者血清促甲状腺激素变化的临床分析  

Serum thyroid stimulating hormone levels in patients with acute cerebrovascular diseases

作　　者：朱健[1,2] 牛富生 李春艳[1] 刘璐[1] 杨篷[1] 李鸿[1] 

机构地区：[1]同济大学附属第十人民医院内分泌科,上海200072 [2]宝山区大场医院内科,上海200444

出　　处：《同济大学学报（医学版）》2015年第4期107-111,共5页Journal of Tongji University(Medical Science)

摘　　要：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1.89 m IU/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1.30 m IU/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. Methods One 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. Results Compared with control group, serum TSH levels in ACVD group were significantly higher（ 1.34± 0.36 v. s. 1. 17 ± 0.94 μU/ml, P 〈 0.05 ）. Compared with mild ACVD group （ 1.01 ± 0.43 μU/ml） serum TSH levels in intermediate （2. 11 ± 1.73 μU/ml） and severe ACVD groups （2. 82 ± 1.06 μU/ml） were significantly higher （ P 〈 0.05 ）. The AUC of TSH for severe ACVD patients was 0. 941 ; with the optimal threshold of 1.89 μU/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 ± 0.44 μU/ml ）, serum TSH levels in patients with improved disease （2.71 ±1.15 μU/ml）and with unchanged disease（3.47 ± 1.61 μU/ml） were significantly higher （P 〈 0. 05 ）. The AUC for predicting poor prognosis was 0. 716; with the optimal threshold of 1.30 μU/ml, the sensitivity and specificity of TSH in predicting poor ACVD prognosis were 60.0% and 77.0%, respectively. Conclusion TSH 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.

关 键 词：急性脑血管病 促甲状腺激素 脑出血 脑梗死 

分 类 号：R743[医药卫生—神经病学与精神病学]