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

doi:10.11817/j.issn.1673-9248.2023.05.008

Abstract

Abstract:

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.

Key words: Stroke, Cognitive impairment, Thyroxine, Epinephrine, Estrogen

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

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Figures/Tables 4

组别	例数	年龄（岁， $x ¯$ ±s）	男/女（例）	受教育年限（例）
组别	例数	年龄（岁， $x ¯$ ±s）	男/女（例）	文盲	≤12年	＞12年
脑梗死组	108	64.77±12.81	64/44	8	74	26
脑出血组	40	63.51±12.91	25/15	3	28	9
对照组	20	66.80±7.84	12/8	2	13	5
统计值^a		t=3.614	χ²=0.175	χ²=0.315
P值		0.076	0.055	0.822
统计值^b		t=0.195	χ²=3.834	χ²=0.297
P值		0.088	0.065	0.533

组别	例数	年龄（岁， $x ¯$ ±s）	男/女（例）	受教育年限（例）
组别	例数	年龄（岁， $x ¯$ ±s）	男/女（例）	文盲	≤12年	＞12年
脑梗死组	108	64.77±12.81	64/44	8	74	26
脑出血组	40	63.51±12.91	25/15	3	28	9
对照组	20	66.80±7.84	12/8	2	13	5
统计值^a		t=3.614	χ²=0.175	χ²=0.315
P值		0.076	0.055	0.822
统计值^b		t=0.195	χ²=3.834	χ²=0.297
P值		0.088	0.065	0.533

组别	例数	T₃[μg/dl，M（Q_R）]	T₄（μg/dl， $x ¯$ ±s）	FT₃（pg/ml， $x ¯$ ±s）	FT₄（ng/dl， $x ¯$ ±s）	TSH[μIU/ml，M（Q_R）]	PRL[ng/ml，M（Q_R）]	FSH[mIU/ml，M（Q_R）]	LH[mIU/ml，M（Q_R）]	GH₂[ng/ml，M（Q_R）]	ACTH[pg/ml，M（Q_R）]	CORT[nmol/L，M（Q_R）]
脑梗死组	108	0.89（0.65，1.01）	7.36±1.74	2.57±0.57	1.27±0.27	3.21（0.63，21.77）	24.43（7.15，123.11）	32.16（8.58，74.91）	15.55（6.28，38.69）	0.88（0.11，23.02）	24.65（13.04，61.03）	527.37（198.64，864.00）
脑出血组	40	0.86（0.53，1.24）	7.85±1.74	2.55±0.49	1.33±0.23	3.89（0.88，24.17）	17.94（10.17，84.49）	14.87（5.43，90.18）	20.89（5.77，40.44）	0.35（0.88，1.13）	23.67（12.49，59.48）	539.72（287.56，971.53）
对照组	20	0.97（0.46，1.25）	8.25±1.24	2.94±0.43	1.27±0.17	2.98（0.47，22.31）	20.66（8.99，134.57）	24.37（6.59，88.52）	19.46（4.71，38.14）	0.94（0.03，1.31）	23.51（11.63，48.32）	489.30（230.67，896.45）
统计值^a		Z=1.202	t=3.147	t=2.848	t=0.315	Z=1.080	Z=0.731	Z=0.822	Z=0.375	Z=3.333	Z=0.976	Z=1.030
P值		0.072	0.011	＜0.001	0.068	0.323	0.079	0.157	0.084	0.043	0.112	0.285
统计值^b		Z=0.719	t=0.945	t=6.179	t=1.313	Z=2.216	Z=0.967	Z=0.444	Z=0.408	Z=2.322	Z=0.117	Z=2.124
P值		0.642	0.075	＜0.001	0.386	＜0.001	0.071	0.098	0.073	0.023	0.436	0.017

组别	例数	T₃[μg/dl，M（Q_R）]	T₄（μg/dl， $x ¯$ ±s）	FT₃（pg/ml， $x ¯$ ±s）	FT₄（ng/dl， $x ¯$ ±s）	TSH[μIU/ml，M（Q_R）]	PRL[ng/ml，M（Q_R）]	FSH[mIU/ml，M（Q_R）]	LH[mIU/ml，M（Q_R）]	GH₂[ng/ml，M（Q_R）]	ACTH[pg/ml，M（Q_R）]	CORT[nmol/L，M（Q_R）]
脑梗死组	108	0.89（0.65，1.01）	7.36±1.74	2.57±0.57	1.27±0.27	3.21（0.63，21.77）	24.43（7.15，123.11）	32.16（8.58，74.91）	15.55（6.28，38.69）	0.88（0.11，23.02）	24.65（13.04，61.03）	527.37（198.64，864.00）
脑出血组	40	0.86（0.53，1.24）	7.85±1.74	2.55±0.49	1.33±0.23	3.89（0.88，24.17）	17.94（10.17，84.49）	14.87（5.43，90.18）	20.89（5.77，40.44）	0.35（0.88，1.13）	23.67（12.49，59.48）	539.72（287.56，971.53）
对照组	20	0.97（0.46，1.25）	8.25±1.24	2.94±0.43	1.27±0.17	2.98（0.47，22.31）	20.66（8.99，134.57）	24.37（6.59，88.52）	19.46（4.71，38.14）	0.94（0.03，1.31）	23.51（11.63，48.32）	489.30（230.67，896.45）
统计值^a		Z=1.202	t=3.147	t=2.848	t=0.315	Z=1.080	Z=0.731	Z=0.822	Z=0.375	Z=3.333	Z=0.976	Z=1.030
P值		0.072	0.011	＜0.001	0.068	0.323	0.079	0.157	0.084	0.043	0.112	0.285
统计值^b		Z=0.719	t=0.945	t=6.179	t=1.313	Z=2.216	Z=0.967	Z=0.444	Z=0.408	Z=2.322	Z=0.117	Z=2.124
P值		0.642	0.075	＜0.001	0.386	＜0.001	0.071	0.098	0.073	0.023	0.436	0.017

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

激素	回归系数	标准误	P值	OR值	95%CI
T₃	0.750	0.992	0.002	0.992	0.257~1.427
T₄	0.163	0.826	0.670	0.826	3.835~9.530
FT₃	1.972	0.162	0.037	8.162	1.152~3.267
FT₄	-0.106	0.842	0.094	1.152	0.958~1.879
TSH	0.168	0.219	0.107	5.263	0.957~30.689
PRL	0.004	0.357	0.394	0.679	10.365~40.659
FSH	-0.283	0.320	0.683	2.842	2.698~56.348
LH	-0.007	0.195	0.265	1.698	2.323~79.634
GH₂	0.199	0.422	0.861	3.375	0.067~87.698
ACTH	-0.036	0.637	0.092	7.624	8.355~77.348
CORT	0.048	0.558	0.510	3.349	357.650~769.530

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