| Objective:By exploring the effects of T3 and FT3/FT4 on the severity of the disease,the prognosis of the 14th day and the 3rd month of the onset in patients with acute ischemic stroke,further study the factors affecting the severity of the disease at the onset and the prognosis at the 14th day and the 3rd month of the onset.Therefore,it lays a foundation for further evaluation of the severity of the disease in patients with first-onset acute ischemic stroke,and provides a certain reference for the prognosis of patients with acute ischemic stroke in clinical work.Methods:(1)A total of 240 patients with acute ischemic stroke who were admitted to the neurology department of a tertiary hospital in Yan’an for the first time from November 2020 to November 2021 were selected as the subjects of this study.(2)Collect patient information after admission:including age,gender,body mass index(BMI),smoking history,drinking history,systolic blood pressure,diastolic blood pressure,history of hypertension,history of atrial fibrillation,hyperlipidemia,diabetes,family history of stroke and NIHSS score at the time of admission.According to TOAST classification,it was divided into:large artery atherosclerotic type,cardioembolic type,small artery occlusion type,other etiological type and unknown etiology type.(3)TSH,T3,T4,FT3,FT4,leukocyte,blood glucose,D-dimer and homocysteine were collected.The size of cerebral infarction was divided into small infarction,medium infarction,and large infarction.(4)Grouping and follow-up:According to the NIHSS score of the National Institutes of Health Stroke Scale,the patients with acute ischemic stroke admitted to the hospital were divided into two groups according to the severity of the disease:<4 points,belonging to the mild group;≥4 points,belong to the moderate to severe group.On the14th day and the 3rd month after the onset of the disease,the m RS scale was used to measure the disability and function of the patients,and the patients were divided into two groups:>2 points,poor prognosis group;≤2 points,good prognosis group.(5)Statistical methods:SPSS 25.0 statistical software package was used,normality(Kolmogorov-Smirnov method)and homogeneity of variance tests were performed.The measurement data subjected to normal distribution was expressed as?±s,and the t test was used for the comparison between the two groups;the measurement data that was not normally distributed was expressed as the median(interquartile range)[M(Q)],and the comparison between the two groups The nonparametric Mann-Whitney rank-sum test was used.Enumeration data were expressed as rates and percentages,and theχ~2 test was used to compare the two groups.The relationship between each index,severity and prognosis were analyzed by binary logistic factor analysis;ROC curve analysis chart were drawn,and the accuracy of marker prediction was judged by measuring the area under the curve(AUC).Results:1.A total of 240 patients with acute ischemic stroke were involved in the study,7 patients who were lost to follow-up during the trial were excluded,and 233patients were finally studied.2.The severity of acute ischemic stroke patients at admission were divided into two groups according to NIHSS scores,there were 123 people in the mild group and 110people in the moderate to severe group;They accounted for 52.79%and 47.21%respectively.Between the two groups,there were statistically significant differences in T3,FT3,FT3/FT4,leukocytes,D-dimer,large atherosclerotic type,small area,and large area.(P<0.05).And the T3,FT3,FT3/FT4 values in the moderate to severe group were lower than those in the mild group.According to binary logistic factor analysis,the difference between T3,FT3/FT4,leukocytes and the severity of acute ischemic stroke patients were statistically significant(P<0.05)after adjusting for confounding factors such as FT3,D-dimer,large atherosclerosis,small area,large area.Among them,T3,FT3/FT4 are independent risk factors for disease severity in patients{T3:odds ratio(OR)=0.306,95%CI=0.105-0.893,P=0.030;FT3/FT4:Odds ratio(OR)=0.000,95%CI=0.000-0.055,P=0.004}.The ROC curve model was drawn,and the results showed that the areas under the curve were 0.680 and 0.694,respectively,indicating that T3,FT3/FT4had significance in predicting the disease severity of patients.3.On the 14th day of the onset of acute ischemic stroke,there were 164 patients in the good prognosis group and 69 patients in the poor prognosis group,they accounted for70.39%and 29.61%respectively.Family history of stroke,large artery atherosclerotic type,small artery occlusive type,small area,large area,age,T4,T3,FT3,leukocytes,D-dimer,homocysteine,FT3/FT4,NIHSS score on admission in different prognosis.The difference between the two groups was statistically significant(P<0.05),and the T4,T3,FT3,FT3/FT4 values were higher in the good prognosis group.The results of binary logistic factor analysis showed that:after eliminating confounding factors such as small area,large area,FT3,leukocytes,D-dimer,etc.,there was a statistically significant difference between T3 and NIHSS score on admission and the prognosis of the patient on the 14th day of the disease(P<0.05).There was no significant difference between FT3/FT4 and the prognosis of patients on the 14th day of the disease(P>0.05);among them,T3 was an independent risk factor for the prognosis of the patient on the 14th day of the disease{T3:odds ratio(OR)=0.207,95%CI=0.064-0.671,P=0.009}.The ROC curve model was drawn,and the results showed that the areas under the curve were 0.745and 0.712,respectively.It can be seen that FT3,FT3/FT4 can still predict the neurological prognosis of patients on the 14th day of onset.4.On the 3rd month of onset of acute ischemic stroke,189 patients belonged to the good prognosis group,and 44 patients belonged to the poor prognosis group;they accounted for 81.12%and 18.88%respectively.Gender,atrial fibrillation,family history of stroke,small-artery occlusive,large area,diastolic blood pressure,T3,FT3,leukocytes,D-dimer,FT3/FT4,NIHSS score on admission in two different prognostic factors.The difference between the groups was statistically significant(P<0.05),and the T3,FT3,FT3/FT4 and diastolic blood pressure values were higher in the good prognosis group.The results of binary Logistic factor analysis showed that after adjusting for confounding factors such as large area,FT3,leukocytes,D-dimer.T3,NIHSS score on admission and the prognosis of the patient on the 3rd month of onset had statistical significance(P<0.05),FT3/FT4 and the prognosis of the patient on the 3rd month of onset had no statistical significance(P>0.05),among them,T3 was an independent risk factor for the prognosis of patients on the 3rd month of onset{T3:odds ratio(OR)=0.018,95%CI=0.003-0.106,P<0.001}.The ROC curve model was drawn,and the results showed that the areas under the curve were 0.857 and 0.763,respectively,indicating that T3,FT3/FT4 had value in predicting the prognosis of patients on the 3rd month of onset.Conclusion:1.T3,FT3/FT4 are independent risk factors affecting the severity of the disease in patients with acute ischemic stroke;The lower the T3 and FT3/FT4 values at admission,the more severe the neurological deficit in patients with acute ischemic stroke.2.T3 level at admission is an independent risk factor affecting short-term prognosis of patients with acute ischemic stroke;The lower the T3 value on admission,the worse the short-term recovery of neurological function in patients with acute ischemic stroke.3.T3,FT3/FT4 can predict the severity of acute ischemic stroke and the short-term prognosis of neurological function to a certain extent. |
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