动脉瘤性蛛网膜下腔出血早期甲状腺激素变化的临床研究  

Clinical Study of Early Changes of Thyroid Hormone in aneurysmal subarachnoid hemorrhage

作　　者：李云飞[1] 汪银洲[1] 程琼[1] 刘君鹏[1] 林守华[1] 魏文[1] LI Yunfei;WANG Yinzhou;CHENG Qiong;LI Yongkun;LIU Junpeng;LIN Shouhua;WEI Wen(Fujian Medical University Provincial Clinical Medical College,Neurology Department of Fujian Provincial Hospital,Fuzhou,Fujian Province,350001 China)

机构地区：[1]福建医科大学省立临床医学院,福建省立医院神经内科,福建福州350001

出　　处：《中外医疗》2021年第9期7-10,共4页China & Foreign Medical Treatment

基　　金：福建省科技厅引导性项目(2016Y0016,2017Y19)。

摘　　要：目的观察动脉瘤性蛛网膜下腔出血患者早期甲状腺功能的变化规律并探讨与损伤变量的关系。方法回顾性分析2016年1月—2018年8月该院收治的84例动脉瘤性蛛网膜下腔出血患者资料,采用化学发光免疫法检测早期甲状腺功能。按结果分为甲功正常组与甲功减退组,收集两组性别、年龄、吸烟、高血压、糖尿病、血脂、尿酸、肌酐、抽搐表现、心肌损伤、hs-CRP、PAASH评分、Hunt-Hess分级、改良Fisher、术前BNI评分、早期脑水肿SEBES评分、术前脑积水、脑室出血、术前mRS评分、动脉瘤位置、动脉瘤大小等指标,先行单因素分析寻找发生急性期甲状腺机能减退的可能危险因素,再将P<0.05的变量纳入Logistic回归分析。结果急性期甲状腺机能减退共29例(34.5%)。单因素分析示早期hs-CRP升高、术前BNI评分、SEBES评分、动脉瘤位置、动脉瘤大小为急性期发生甲状腺功能减退的危险因子,多因素分析示动脉瘤大小(OR=1.368,95%CI:1.067~1.755,P=0.014)是独立危险因素。结论甲状腺机能减退是在蛛网膜下腔出血急性期的常见现象。动脉瘤大小是发生早期甲状腺功能减退的独立预测因素。建议对非小动脉瘤患者进行动态的内分泌随访。Objective To observe the early changes of thyroid function in patients with aneurysmal subarachnoid hemorrhage and to explore the relationship with injury variables.Methods The data of 84 patients with aneurysmal subarachnoid hemorrhage in the hospital from January 2016 to August 2018 were retrospectively analyzed.Chemiluminescence immunoassay was used to detect early thyroid function.According to the results,they were divided into thyroid function normal group and thyroid hypofunction group.The two groups were collected by gender,age,smoking,hypertension,diabetes,blood lipids,uric acid,creatinine,twitch performance,myocardial injury,hs-CRP,PAASH score,Hunt-Hess classification,modified Fisher,preoperative bleeding BNI score,early cerebral edema SEBES score,preoperative hydrocephalus,ventricular hemorrhage,preoperative mRS score,aneurysm location,aneurysm size and other indicators,and univariate analysis was performed to find the occurrence of acute hypothyroidism risk factors of P<0.05,and the variables were included in the Logistic regression analysis.Results There were 29 cases(34.5%)of acute hypothyroidism.Univariate analysis showed that early hs-CRP elevation,preoperative BNI score,SEBES score,aneurysm location,and aneurysm size were risk factors for hypothyroidism in the acute phase.Multivariate analysis showed aneurysm size(OR=1.368,95%CI:1.067-1.755,P=0.014)was an independent risk factor.Conclusion Hypothyroidism is a common phenomenon in the acute phase of subarachnoid hemorrhage.The size of aneurysm is an independent predictor of early hypothyroidism.It is recommended that patients with non-small aneurysms undergo dynamic endocrine follow-up.

关 键 词：动脉瘤 蛛网膜下腔出血 甲状腺功能减退 

分 类 号：R651[医药卫生—外科学]