A Clinical Study On The Functional Changes Of Hypothalamic-pituitary-adrenal Axis In Patients With Poststroke Fatigue

ObjectiveThe change of he hypothalamus-pituitary-adrenal axis(HPA axis)function in patients with poststroke fatigue(PSF)and its clinical significance.MethodsPatients with ischemic stroke who were hospitalized in the department of neurology of Chifeng College Affiliated Hospital from January 2017 to December 2018 were selected as the study subjects.According to the scores of the fatigue severity scale(FSS),those with PSF were as the study group and those without PSF were as the case control group,and healthy physical examination patients with the same age and gender matching were selected as the normal control group(NC group).All the enrolled patients were evaluated by volume of infarction,NIHSS scale and FSS score.The blood cortisol(Cor),adrenocorticotropic hormone(ACTH)and corticotropin releasing hormone(CRH)level was tested in all subjects.And the relationship between Cor,ACTH and CRH and the occurrence and severity of PSF was analyzed.Results1.Comparison of the general data between the three groups and the infarct volume,neurological function score and fatigue score of the enrolled patientsA total of 120 patients with ischemic stroke were included,including39 subject as study group and 81 subjects as control group.The NC group included 60 subjects.There was no significantly difference in age and gender among the three groups(P>0.05).There was no significantly difference in lifestyle and complication between the study group and the case control group(P>0.05);NIHSS score(23.22±2.41)and FSS score(5.24±0.60)in the study group were significantly higher than those in control group,whose NIHSS score is 20.52±1.84 and FSS score is 2.01±0.94(P<0.05).The infarct volume of patients in the study group(8.75±0.90cm3)was not significantly different from that of patients in the control group(7.89±1.56cm3)(P>0.05).2.Comparison of the levels of serum Cor,ACTH and CRH among three groupsThe level of serum Cor,ACTH and CRH in the study group were significantly higher than that in control group and normal control group(P<0.05).3.Correlation between FSS score and serum Cor,ACTH and CRH in study groupPearson correlation analysis was conducted between FSS score and the level of serum Cor,ACTH and CRH.The results showed that FSS score was positively correlated with the level of serum Cor,ACTH and CRH(r values of0.24,0.29 and 0.38,P<0.05).Conclusions1.The function of HPA axis in PSF patients is abnormal.And the secretion of Cor,ACTH and CRH disorders may be contributed to the pathophysiological process of PSF.2.The levels of serum Cor,ACTH and CRH were positively correlated with the severity of PSF.The higher the level,the more severe the fatigue of PSF patients.