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中华脑血管病杂志(电子版) ›› 2023, Vol. 17 ›› Issue (05) : 471 -476. doi: 10.11817/j.issn.1673-9248.2023.05.008

临床研究

脑卒中后认知障碍与内分泌激素变化的关系
孙畅, 赵世刚(), 白文婷   
  1. 137400 内蒙古乌兰浩特,兴安盟人民医院神经内科;010000 呼和浩特,内蒙古医科大学附属医院神经内科
    010000 呼和浩特,内蒙古医科大学附属医院神经内科
    137400 内蒙古乌兰浩特,兴安盟人民医院神经内科
  • 收稿日期:2022-12-06 出版日期:2023-10-01
  • 通信作者: 赵世刚
  • 基金资助:
    国家自然科学基金资助项目(82160248)

The relationship between the cognitive impairment after stroke and the hormone levels

Chang Sun, Shigang Zhao(), Wenting Bai   

  1. Department of Neurology, Xing'anmeng People's Hospital, Ulanhot 137400, China; Department of Neurology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010000, China
    Department of Neurology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot 010000, China
    Department of Neurology, Xing'anmeng People's Hospital, Ulanhot 137400, China
  • Received:2022-12-06 Published:2023-10-01
  • Corresponding author: Shigang Zhao
引用本文:

孙畅, 赵世刚, 白文婷. 脑卒中后认知障碍与内分泌激素变化的关系[J/OL]. 中华脑血管病杂志(电子版), 2023, 17(05): 471-476.

Chang Sun, Shigang Zhao, Wenting Bai. The relationship between the cognitive impairment after stroke and the hormone levels[J/OL]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2023, 17(05): 471-476.

目的

探讨不同认知水平的脑卒中患者体内内分泌激素水平与认知障碍发生的关系。

方法

选取2012年12月至2013年12月入住内蒙古医科大学附属医院神经内科的患者,根据入组标准选取脑梗死组患者108例和脑出血组患者40例,选择同期神经系统检查无确诊脑血管及内分泌系统疾病者作为对照组(20例)。使用蒙特利尔认知评估量表(MoCA)评估脑梗死组患者的认知功能并分为认知功能高水平组(MoCA评分≥23分,41例)、中水平组(MoCA评分≥15分且<23分,38例)、低水平组(MoCA评分<15分,29例)3组。全部研究对象统一采集血标本并测定其血清三碘甲状腺原氨酸(T3)、血清甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)、血清泌乳素(PRL)、血清促卵泡刺激素(FSH)、血清促黄体生成素(LH)、血清生长激素(GH2)、促肾上腺皮质激素(ACTH)和皮质醇(CORT)水平。采用两独立样本t检验及Mann-Whitney U检验比较脑梗死组、脑出血组与对照组间以及不同认知功能水平组间激素水平的差异,使用Logistic回归分析法分析脑出血认知功能与各激素水平变化间关系。

结果

与对照组比较,脑梗死组出现了T4、FT3、GH2水平降低[(7.36±1.74)μg/dl vs(8.25±1.24)μg/dl;(2.57±0.57)pg/ml vs(2.94±0.43)pg/ml;0.88(0.11,23.02)ng/ml vs 0.94(0.03,1.31)ng/ml],差异均具有统计学意义(t=3.147,P=0.011;t=2.848,P<0.001;Z=3.333,P=0.043),脑出血组出现了FT3、GH2水平降低[(2.55±0.49)pg/ml vs(2.94±0.43)pg/ml;0.35(0.88,1.13)ng/ml vs 0.94(0.03,1.31)ng/ml]和TSH、CORT水平升高[3.89(0.88,24.17)μIU/ml vs 2.98(0.47,22.31)μIU/ml;539.72(287.56,971.53)nmol/L vs 489.30(230.67,896.45)nmol/L],差异均具有统计学意义(t=6.179,P<0.001;Z=2.322,P=0.023;Z=2.216,P<0.001;Z=2.124,P=0.017),余激素水平比较差异均无统计学意义(P均>0.05)。脑梗死后认知功能高、中、低水平组间其T3变化存在差异,FT3在认知功能高中组间、高低组间,ACTH在认知功能中低组间、高低组间变化存在差异,差异均具有统计学意义(P均<0.017)。Logistic回归分析显示,脑出血患者的T3、FT3水平为卒中后认知障碍的危险因素(回归系数=0.750、1.972,OR=0.992、8.162,P=0.002、0.037)。

结论

急性脑卒中后患者分别出现甲状腺功能、ACTH、CORT和GH2水平的变化,且变化趋势与卒中后认知功能改变呈一定相关性。

Objective

To investigate the relationship between endocrine hormone levels and cognitive impairment in stroke patients with varying degrees of cognitive function.

Methods

Patients admitted to the Neurology Department of Inner Mongolia Medical University Affiliated Hospital between December 2012 and December 2013 were enrolled in the study. Based on the inclusion criteria, 108 cases of cerebral infarction and 40 cases of cerebral hemorrhage were included as the stroke group, while another 20 patients without diagnosed cerebrovascular or endocrinological disorders were included as the control group. The Montreal Cognitive Assessment (MoCA) was used to assess the cognitive function of stroke patients, and they were classified into three subgroups: high-level cognitive function group (MoCA score ≥23, 41 cases), medium-level cognitive function group (MoCA score ≥15 and <23, 38 cases), and low-level cognitive function group (MoCA score <15, 29 cases).All participants' blood samples were collected for the measurement of serum levels of triiodothyronine (T3), tetraiodothyronine (T4), free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), prolactin (PRL), follicle-stimulating hormone (FSH), luteinizing hormone (LH), human growth hormone (GH2), adrenocorticotropic hormone (ACTH), and cortisol (CORT). The hormone levels among the stroke group (cerebral infarction and cerebral hemorrhage) and the control group, as well as among different cognitive function level subgroups, were compared using independent-samples t-tests and Mann-Whitney U tests. Furthermore, Logistic regression analysis was performed to examine the relationship between cognitive function and hormone level changes in the cerebral hemorrhage group.

Results

Compared with the control group, the levels of T4, FT3, and GH2 decreased in the ischemic stroke group [(7.36±1.74) μg/dl vs (8.25±1.24) μg/dl; (2.57±0.57) pg/ml vs (2.94±0.43) pg/ml; 0.88 (0.11, 23.02) ng/ml vs 0.94 (0.03, 1.31) ng/ml] ,with statistically significant differences (t=3.147, P=0.011; t=2.848, P<0.001; Z=3.333, P=0.043). There were no significant differences in the levels of other hormones (P>0.05). The hemorrhagic stroke group showed decreased levels of FT3; GH2 [(2.55±0.49 pg/ml vs 2.94±0.43 pg/ml);(0.35 (0.88, 1.13) ng/ml vs 0.94 (0.03, 1.31) ng/ml)], and increased levels of TSH, CORT[(3.89 (0.88, 24.17) μIU/ml vs 2.98 (0.47, 22.31) μIU/ml); (539.72 (287.56, 971.53) nmol/L vs 489.30 (230.67, 896.45) nmol/L)], with statistically significant differences (t=6.179, P<0.001; Z=2.322, P=0.023; Z=2.216, P<0.001; Z=2.214, P=0.017). There were no significant differences in the levels of other hormones (P>0.05). Differences in T3 and FT3 were observed among different cognitive function levels in the ischemic stroke group, while differences in ACTH were observed between the middle-low and high-low cognitive function subgroups. These differences were statistically significant (P<0.017). Logistic regression analysis showed that the levels of T3 and FT3 in hemorrhagic stroke patients were risk factors for post-stroke cognitive impairment (β=0.750, 1.972; OR=0.992, 8.162; P=0.002, 0.037).

Conclusion

Patients with acute cerebrovascular disease showed changes in thyroid function, cortisol and adrenocorticotropic hormone levels, and growth hormone levels, and these changes were correlated with post-stroke cognitive impairment.

表1 脑梗死组、脑出血组与对照组一般临床资料比较
表2 脑梗死组、脑出血组与对照组各激素水平情况比较
表3 脑梗死患者不同认知水平组间各激素水平变化的关系[MQR)]
组别 例数 T3(μg/dL) T4(μg/dL) FT3(pg/ml) FT4(ng/dl) TSH(μIU/ml) PRL(ng/ml) FSH(mIU/ml) LH(mIU/ml) GH2(ng/ml) ACTH(pg/ml) CORT(nmol/L)
高水平组 41 0.96(0.91,1.38) 7.35(5.89,10.25) 2.03(1.00,3.15) 1.35(0.79,1.87) 3.89(0.54,19.75) 18.74(9.59,187.53) 24.56(10.23,107.94) 18.73(8.01,40.69) 0.35(0.12,0.87) 25.43(10.54,72.03) 587.11(224.00,1013.47)
中水平组 38 0.89(0.74,1.12) 6.33(4.37,12.00) 1.99(0.89,3.88) 1.42(0.87,1.88) 3.56(0.87,25.73) 17.49(11.35,184.23) 18.88(7.38,64.84) 20.15(3.94,40.06) 0.64(0.09,1.17) 24.89(10.93,48.8) 488.75(232.08,975.16)
低水平组 29 0.94(0.80,1.25) 6.88(5.23,9.84) 2.55(0.84,3.00) 1.58(0.67,1.76) 3.03(0.33,20.85) 32.56(8.89,145.77) 30.54(7.38,83.46) 17.89(6.43,39.78) 0.74(0.13,1.50) 23.00(11.01,72.64) 524.49(199.00,943.18)
Z值(高-中组) 17.333 0.806 40.124 3.368 2.783 0.506 0.158 0.009 2.741 0.671 0.394
P值(高-中组) <0.001 0.148 0.003 0.395 0.084 0.262 0.069 0.085 0.076 0.344 0.0527
Z值(中-低组) 5.464 2.502 2.287 0.796 0.458 0.012 1.816 0.819 2.486 6.374 0.741
P值(高-低组) 0.007 0.035 0.045 0.083 0.396 0.075 0.242 0.642 0.052 <0.001 0.131
Z值(中-低组) 24.444 4.230 32.690 4.207 0.430 0.470 0.810 0.968 0.002 5.894 0.020
P值(高-低组) <0.001 0.213 0.021 0.084 0.192 0.047 0.802 0.044 0.231 0.015 0.533
表4 脑出血患者认知功能与各激素水平变化间的关系
1
《中国脑卒中防治报告》编写组. 《中国脑卒中防治报告2019》概要 [J]. 中国脑血管病杂志, 2020, 17(5): 272-281.
2
汪凯, 董强. 卒中后认知障碍管理专家共识2021 [J]. 中国卒中杂志, 2021, 16(4): 376-389.
3
贾建平, 王荫华, 张振馨, 等. 中国痴呆与认知障碍诊治指南(三): 神经心理评估的量表选择 [J]. 中华医学杂志, 2011, 91(11): 735-741.
4
宋颢, 孙冬, 章军建. 《2019年中国血管性认知障碍诊治指南》解读 [J]. 中国临床医生杂志, 2021, 49(6): 655-657655-657, 661.
5
王科英, 恽晓萍. 日常注意成套测验(汉化版)对脑损伤后注意障碍的诊断价值 [J]. 中华物理医学与康复杂志, 2020, 42(8): 690-693.
6
肖丽, 邵蓓, 蒋慧刚, 等. 雌激素对脑卒中后抑郁大鼠行为学和神经再生的剂量相关性研究 [J]. 中国临床神经科学, 2014, 22(2): 154-159.
7
Lee PR, Brady D, Koenig JI. Thyroid hormone regulation of N-methyl-D-asparetic acid receptor subunit mRNA expression in adult brain [J]. J Neuroendocrinol, 2003, 15(1): 87-92.
8
Janowsky JS. The role of and orgens in cognition and brain aging in men [J]. Neuroscience, 2006, 138(3): 1015-l020.
9
Sayeed I, Parvez S, Wali B, et al. Direct inhibition of the mitochondrial permeability transition pore:a possible mechanism for better neuroprotective effects of allopregnanolone over progesterone [J]. Brain Res, 2009, 1263: 165-173.
10
中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组. 中国急性缺血性脑卒中诊治指南2010 [J]. 中国全科医学, 2011, 35: 4013-4017.
11
卫生部疾病控制司, 中华医学会神经病学分会. 中国脑血管病防治指南 [J]. 中国现代神经疾病杂志, 2006, 6(3): 210.
12
周智林, 梁丽贞, 严永兴. 阿尔茨海默病和血管性痴呆患者甲状腺功能的研究 [J]. 中华神经科杂志, 2005, 38(2): 116-117.
13
李峥嵘, 刘芸芸, 季永欣. 动态检测甲状腺激素水平在急性脑卒中的应用价值 [J]. 现代实用医学, 2019, 31(3): 334-336.
14
Zwppe Uini R, Alsa F, Gheno G, et al. Cardiac injury in acute cerebral apoplexy [J]. Ann Ital Med Int, 2001, 16(2): 73-81.
15
袁莉莉, 栾迪, 杨倩, 等. 甲状腺疾病与认知障碍的研究进展 [J]. 中国神经精神疾病杂志, 2020, 46(6): 368-371.
16
Lillevang-Johansen M, Petersen I, Christensen K, et al. Is previous hyperthyroidism associated with longterm cognitive dysfunction? A twin study [J]. Clin Endocrinol, 2014, 80(2): 290-295.
17
Chen H, Wu Y, Huang G, et al. Low Triiodothyronine syndrome is associated with cognitive impairment in patients with acute ischemic stroke:a prospective cohort study [J]. Am J Geriatr Psychiatry, 2018, 26(12): 1222-1230.
18
Chen Y, Tian Z, Liang Z, et al. Brain gene expression of a sporadic (icv-STZ Mouse) and a familial mouse model (3 xTg-AD mouse) of Alzheimer's disease [J]. PLoS One, 2012, 7(12): e51432.
19
颜靖文, 顾耘. 从老年性痴呆探讨神经-内分泌-免疫网络与神经干细胞之间的关系 [J]. 中华中医药学刊, 2012, 30(7): 1518-1520.
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