Relationship Between Subclinical Hypothyroidism And Functional Prognosis In Patients With Acute Cerebral Infarction

Background and objectiveCerebral infarction,also known as ischemic stroke,refers to the lack of regional cerebral blood flow due to various causes,and ischemic and hypoxic brain tissue necrosis and softening.The burden of stroke in China is heavy,according to the third national survey on the cause of death,the cerebrovascular disease has become the leading cause of death for urban and rural residents in China.It is estimated that there are 2.4 million new strokes each year in China,1.1 million stroke-related deaths,and 11.1 million stroke survivors.The study showed that the improvement of treatment technology and health awareness,the incidence of hyperthyroidism,hypothyroidism,etc.continued to decline,but the incidence of subclinical hypothyroidism was explosive growth,the awareness rate and treatment rate of subclinical hypothyroidism was low,failed to raise attention of clinical doctors and the public.Previous studies have shown that thyroid disease is closely related to the onset and functional prognosis of cerebral infarction,but subclinical hypothyroidism and cerebral infarction prognosis studies are few and controversial.In this study,a prospective cohort study was conducted on the etiology,demographic characteristics,auxiliary examinations,imaging data,and functional prognosis of acute cerebral infarction patients admitted to the First Affiliated Hospital of Zhengzhou University to explore subclinical hypothyroidism and acute brain.The functional prognosis of infarct patients,and the prevalence of subclinical hypothyroidism in patients with acute stroke was roughly calculated,raising the awareness of clinical doctors on subclinical hypothyroidism.Patients and Methods PatientsThe cases originated from the database of acute ischemic stroke and transient ischemic attack(TIA)in Henan Province.From July 2013 to December 2016,Prospective and consecutive inclusion of patients with acute ischemic stroke in Department of Neurology and Neurointervention in First Affiliated Hospital of Zhengzhou University MethodsProspective,observational,continuous,single-center stroke registration studies based on hospital admissions.Record the basic socio-demographic data(age,sex,occupation,etc.),clinical information,treatment methods,past medical history,laboratory findings and test results of patients who meet the criteria for Inclusion and exclusion,and complete at least 90 days of follow-up.Patients with thyroid stimulating hormone(TSH)? 4.05 mIU/L were in subclinical hypothyroidism(SCH,Subclinical Hypothyroidism)group;patients with 0.1mIU/L ? TSH ? 4.05mIU/L were in normal thyroid function group.The patients included were followed up by telephone and mRS scores were used to evaluate their functional prognosis.According to mRS scores of 90-day follow-up,patients were divided into Fully functional group(mRS score ? 1 point)and Non-fully functional group(mRS score ? 2).Comparing the baseline data of the SCH group and the normal thyroid function group,explore the differences between the two groups of patients.Through a Fully functional group and Non-functional fully group,gender,age,past history,hypertension,smoking history,diabetes,coronary heart disease,hyperlipidemia,atrial fibrillation,first NIHSS score after admission and other related factors were analyzed by univariate and multivariate logistic regression to explore the relationship between subclinical hypothyroidism and functional outcomes.P <0.05(bidirectional)was considered to indicate that the difference was statistically significant.The odds ratio(OR)and its 95% confidence interval(CI)were calculated..ResultsDuring the study period,a total of 2283 patients with acute cerebral infarction who were diagnosed on the 14 th day after onset were collected.Among them,1462 were missing from key examinations such as thyroid function tests and cranial MRI;65 with intravenous thrombolysis,mechanical thrombectomy,bridging therapy in the acute phase and other endovascular treatments were performed or meeting other exclusion criteria,51 were lost to follow-up,and 705 were eventually included.Among them,64 were subclinical hypothyroidism cases,accounting for 9.1%;475 were females,accounting for 32.6%;average age was 56.84±13.11 years;average NIHSS score was 4.42±4.3 points;340 cases were smoking patients,accounting for 48.2%;Cases,accounting for 26.1%;57 cases of coronary heart disease,accounting for 8.1%;438 cases of hypertension,accounting for 62.1%;193 cases of diabetes,accounting for 27.4%;25 cases of atrial fibrillation,accounting for 3.5%;181 lipid metabolism disorders,accounting for 27.4%.A total of 435 patients(61.7%)had fully independent function and 270(38.3%)had Non-fully independent function.Baseline data on subclinical hypothyroidism and euthyroid showed there were statistical differences between age(p<0.001),gender(p<0.001),history of hypertension(p<0.05),history of stroke(p<0.05),hemoglobin(p = 0.03),red blood cells(p = 0.02)and direct bilirubin(p = 0.03).According to the results of the 90-day mRS score,the included cases were divided into Fully functional group and Non-fully functional group.Univariate analysis showed that age(p<0.01),first NIHSS score after admission(p<0.001),and the functional prognosis of patients with acute cerebral infarction was statistically significant.with subclinical hypothyroidism in Fully functional group and Non-fully functional group(10.1% vs 7.1%)was different,but lacking statistical significance(p=0.224).All included cases were divided into small stroke group(NIHSS ? 3 points,377 cases)and Non-small stroke group(NIHSS> 3 points,328 cases)according to the baseline NIHSS score.Univariate analysis was performed on the functional prognosis of the small stroke group and the Non-small stroke group,respectively.It can be seen that the age(p<0.001),hypertension(p<0.05),atrial fibrillation(p<0.05),history of stroke(p<0.01),and prognosis of cerebral infarction in small stroke group were statistically significant.There was a trend associated with the prognosis of cerebral infarctionlipid metabolism disorder(p= 0.053),and subclinical hypothyroidism(p=0.385)was not statistically significant between the Fully functional group and Non-fully functional group groups.In the Non-small stroke group,subclinical hypothyroidism(p=0.069)and smoking(p<0.1)had a trend associated with stroke prognosis,age(p=0.216),hypertension(p=0.394),and atrial fibrillation(p= 0.616)and stroke history(p=0.731)were not statistically significant.Univariate analysis of variables with P < 0.1(age,NIHSS score of admission),recognized risk factors for cerebral infarction(smoking history,history of stroke,history of coronary heart disease,hypertension,diabetes,dyslipidemia,atrial fibrillation),and subclinical hypothyroidism in function as independent variables,and whether the prognosis of cerebral infarction function was good was a binary variable to conduct multivariate logistic regression analysis to screen for independent risk factors of functional prognosis in patients with acute cerebral infarction.The results showed age,admission NIHSS score,dyslipidemia,subclinical hypothyroidism were statistically significant.According to the first nihss score after admission,the patients were divided into small stroke group and Non-small stroke group.In the small stroke group age was associated with functional outcome,while there was no statistical difference in the prognosis of acute cerebral stroke and subclinical hypothyroidism etc.In the Non-small stroke group subclinical hypothyroidism,age,and functional outcome were statistically significant.According to whether the age is greater than 70 years old,patients are divided into elderly group(Age ? 70 years old)and non-elderly group(Age <70 years old).In the elderly group,there was no statistical difference in functional outcome of acute cerebral stroke and subclinical hypothyroidism.In non-elderly group,subclinical hypothyroidism and functional outcome were statistically significant.ConclusionSubclinical hypothyroidism may is an independent protective factor for functional prognosis in patients with acute cerebral infarction.