甲状腺激素水平与亚急性联合变性神经损害程度及预后的相关性研究  

Study on the correlation between the level of thyroid hormone and the severity of nerve damage and prognosis of subacute combined degeneration

作　　者：李小玉 骆嵩[1] 刘成玉 罗文平 刘晓林[1] LI Xiaoyu;LUO Song;LIU Chengyu;LUO Wenping;LIU Xiaolin(The First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China)

机构地区：[1]蚌埠医学院第一附属医院,安徽蚌埠233004

出　　处：《中国实用神经疾病杂志》2021年第18期1591-1599,共9页Chinese Journal of Practical Nervous Diseases

基　　金：安徽省高校自然科学研究重点项目(编号:KJ2019A0364);中匈科学合作基金-青年学者计划(编号:2019)。

摘　　要：目的探讨亚急性脊髓联合变性患者血清甲状腺激素水平与神经损害程度及临床预后的相关性。方法对2019-01—2021-01入住蚌埠医学院第一附属医院神经内科的31例亚急性脊髓联合变性患者与同时期31例健康体检者的一般资料、实验室结果进行回顾性分析。使用功能残疾等级量表评分(FDS评分)、改良Rankin量表(mRS评分)分别评估入院时的神经功能缺损严重程度及出院6个月后的预后恢复情况,用Logistic回归分析SCD患者不良预后的危险因素,判断甲状腺激素水平对患者神经功能缺损程度及预后是否具有指示意义。结果与健康对照组比较,SCD患者中饮酒者11例(17.74%),促甲状腺激素(TSH)[(3.88±2.5)mIU/L]、平均红细胞体积(MCV)[(101.50±11.92)fL]、同型半胱氨酸(Hcy)[(14.96±10.41)μmol/L]水平升高,维生素B12[(219.03±211.11)pg/mL]、血红蛋白(HB)[(113.54±22.41)g/L]水平降低,差异有统计学意义(P<0.05)。伴甲状腺功能减退者FDS评分(7.17±2.71)及mRS评分(2.50±1.22)均较甲状腺功能正常者高,mRS评分差异有统计学意义(P<0.05)。二元Logistic回归分析示,入院FDS评分(OR=2.166,P=0.048)及TSH水平(OR=2.856,P=0.046)是SCD患者预后不良的独立危险因素。结论甲状腺激素水平与亚急性脊髓联合变性的神经功能缺损程度及预后有一定的相关性,激素水平异常对该病的严重程度及临床预后有一定的指示意义。Objective To explore the indicative significance of serum thyroid hormone level,disease severity and clinical prognosis in patients with subacute combined spinal cord degeneration.Methods The general data and laboratory results of 31 patients with subacute combined spinal cord degeneration who were admitted to the Department of Neurology of the First Affiliated Hospital of Bengbu Medical College from January 2019 to January 2021 and 31 healthy subjects in the same period were retrospectively analyzed.Use the functional disability rating scale score(FDS score)and the modified Rankin scale(mRS score)to evaluate the severity of neurological deficits at admission and the prognosis recovery 6 months after discharge.Logistic regression was used to analyze the risk factors of poor prognosis in SCD patients to determine whether the level of thyroid hormone has indicative significance on the degree of neurological deficit and prognosis of patients.Results Compared with the healthy control group,11 of SCD patients(17.74%)drink alcohol,thyroid-stimulating hormone(TSH)(3.88±2.5)mIU/L,mean red blood cell volume(MCV)(101.50±11.92)fL,homocysteine(Hcy)(14.96±10.41)μmol/L levels increased,vitamin B_(12)(219.03±211.11)pg/mL,hemoglobin(HB)(113.54±22.41)g/L levels decreased,with statistical differences(P<0.05).The FDS score(7.17±2.71)and mRS score(2.50±1.22)of patients with hypothyroidism were higher than those with normal thyroid function,and the difference in mRS score was statistically significant(P<0.05).Binary Logistic regression analysis showed that admission FDS score(OR=2.166,P=0.048)and TSH level(OR=2.856,P=0.046)were independent risk factors for poor prognosis in SCD patients.Conclusion There is a certain correlation between the level of thyroid hormone and the degree of neurological deficit and prognosis of subacute combined degeneration of the spinal cord.Abnormal hormone levels are indicative of the severity of the disease and the clinical prognosis.

关 键 词：亚急性脊髓联合变性 甲状腺功能减退 维生素B_(12) 同型半胱氨酸 预后 

分 类 号：R744.6[医药卫生—神经病学与精神病学]