The Correlation Clinical Research Of Acute Cerebral Infarction With Low T₃ Syndrome

Part I the Clinical Significance of Low T₃ Syndrome in Different Subtypes of Acute Cerebral InfarctionResearch background:The low triiodothyronine （T₃） syndrome is a sign of poor prognosis for patients with acute cerebral infarction severe neurologic deficits. Whether the various subtypes of acute cerebral infarction, basic conditions and the severity of these diseases at the time of admission to hospital with low T₃ syndrome or not are difference, there was not any more literature reports before.Objective:To explore comparing neurological deficits score and proportion of different subtypes of ACI patients with LTS.Methods:163 patients with acute cerebral infarction, collected in the Department of Neurology, Affiliated Suzhou Hospital of Nanjing Medical University （Suzhou Municipal Hospital） from December 2012 to December 2014, by the CT/MRI diagnosis definitively. We divided these patients into two groups based upon examined thyroid hormone levels, including low T₃ group （LTS group,30 cases） and normal group T₃ group （control group, 133 cases）. According to the imaging results by TOF-MRA/MRA/CTA/DSA, the etiologies according to TOAST classification system were determined. Collecting these patients clinical relevant informations and sing the National Institutes of Health stroke scale （NIHSS） score at the worst condition during the time of hospitalization, so called peak NIHSS score. We compared the risk factors and the severity of the disease and analysed these statistical data, in order to better understand the characteristics underlying the even worse of the prognosis of patients with cerebral infarction with low T₃ syndrome.Results:1. Compared with the normal T₃ group found that group of these patients with cerebral infarction with low T₃ syndrome was even older（p<0.001）, the proportion of women was more （p=0.002）, high blood pressure patients was more （p=0.04）。 High homocysteine levels in low T₃ syndrome group, with a rate sigtnificantly higher than the control group（p=0.001）,but the proportion of smokers was dramatically less than the control group（p=0.008）,that is to say, LTS group compared with the normal T₃ group, Age, gender, hypertension, high homocysteine, was statistically significant（all p<0.05）. Patients in cerebral infarction with low T₃ syndrome, less smoking rate, May be because women in this study paid more, or sample size too little. Other risk factors included history of stroke or TIA, atrial fibrillation, hypercholesterolemia, hyperuricemia have no obvious statistical difference （all p>0.05）.2. According to the TOAST classification of the cerebral infarction be sorted five subtypes, to compare five subtypes during hospitalization NIHSS score in low T₃ group and control group patients. It resulted that discharge NIHSS score ether in each subtype of patients with cerebral infarction patients with low T₃ syndrome group or in normal T₃ group had no obvious difference （P> 0.05）.3. According to the anatomy of the cerebral infarction further divided into anterior circulation and posterior circulation by vascular distribution, and then,the subtype of artery atherosclerotic cerebral infarction accompanied in internal carotid artery system（LAA-ICA） at peak NIHSS score combined with LTS patients was significantly higher than normal T₃ group（14.89±9.37 vs 5.14±3.21, P=0.014）. The proportion of NIHSS score≥8 in the patients with LAA-ICA-associated cerebral infarction accompanied by LTS was significantly higher than in those without LTS（p=0.001）, The results had significance（p<0.005）.Conclusions:1. We concluded that increased numbers of risk factors for cerebral infarction with low T₃ syndrome than those with normal T₃.2. It found that more severe neurological deficits, which may more likely occur in patients with the subtype of artery atherosclerotic cerebral infarction accompanied in internal carotid artery system （LAA-ICA） with low T₃ syndrome.3. We think that increased numbers of risk factors and more severe neurological deficits in patients with LAA-ICA, may be the important causes for its worse prognosis.4. we also consider that age and female gender are important risk factors of patients with acute cerebral infarction, Therefore intense secondary prevention in patients with cerebral infarction, especially in those with elderly women is particularly important.Part Ⅱ Analysis of Risk Factors and Prognosis in Cerebral Infarction due to Large Artery Atherosclerosis Patients Combined with Low T₃ SyndromeResearch background:Low triiodothyronine （T₃） syndrome （LTS） often appears in all kinds of severe non-thyroid diseases, which is closely related with the severity and prognosis of these diseases. In recent years, the relationship between LTS and cardiovascular diseases is more and more becoming the research hot spot, however relevant clinical research reports with acute cerebral infarction is still rare.Objective:To explore importantly:various risk factors for severe neurological deficits and the prognosis in patients with large artery atherosclerosis cerebral infarction combined with LTS.Methods:All patients, diagnosed definitively acute cerebral infraction, were admitted and treated in the Department of Neurology of Suzhou Municipal Hospital from December 2012 to March 2015.208 patients with acute LAA-CI was chosen and divided into two groups:Low T₃ group （LTS） and normal T₃ group （control group）, based on examined thyroid hormone levels. And we also collected the relevant clinical data of patients on admission to our hospital, such as:age, gender, history of TIA or stroke, history of hypertension or diabetes, smoking history, hemoglobin, uric acid, total cholesterol, triglycerides, high-density lipoproteins （HDL） and low-density lipoproteins （LDL） and image data of CT or MRI, and so on. NIHSS score on admission to hospital and mRS one year later was collected as well.The data was for statistical analysis.Results:1.151 cases of patients were found with normal T₃ levels （control group） and 57 cases of patients with LTS （LTS group）. Compared with patients in control group, significantly lowered T₃ levels and elevated TSH levels were found in LTS group （all P<0.05）. The results have statistical significance.2. According to the comparative analysis of multiple risk factors between the two groups:age, systolic blood pressure, NIHSS score on admission and proportion of patients with diabetes mellitus in LTS group were higher than those in control group（all P <0.05）.3. Age and NIHSS on admission were closely related with incidence of LTS in logistic regression analysis （all P<0.05）.4. Proportion of mRS with 3-6 or with 6 at one year after the event in LTS group was higher than that in control group （all P<0.05）. According to follow-up results, those patients in cerebral infarction combined low T₃ syndrome had poorer prognosis.Conclusions:Those patients in cerebral infarction combined low T₃ syndrome had poorer prognosis. according to one-year follow-up results, poor prognosis was found in LAA-CI patients with LTS. Advanced age and severe neurological deficits may serve as independent risk factors for those patients.