The Correlation Between Subclinical Hypothyroidism And Carotid Atherosclerosis In Patients With Acute Ischemic Stroke

Background:Cerebral ischemic stroke,also known as“brain infarction”,is caused by obstruction of arteries supplying blood to the brain,resulting in decreased blood flow or interruption of blood supply,ischemia and hypoxia and necrosis of brain tissue,and corresponding symptoms of neurological deficits,which account for60%to 80%of the total stroke.The China Stroke Association’s first report on stroke in China in 2015 shows that there are about 2.7 million new cerebrovascular disease patients are added each year in China.About 1.3 million patients die of cerebrovascular disease every year.Every 12 seconds,there are people who have a stroke.Every 21 seconds,there are people who die due to stroke,and the stroke is domestic.The first cause of death.The economic burden of stroke on China is as high as 40 billion yuan per year,and it is on the rise.Research evidence suggests that more than 80%of strokes can be prevented by controlling risk factors for early prevention.Exploring risk factors for stroke and early intervention are essential for reducing stroke and death.Atherosclerosis is a systemic inflammatory disease of the arterial wall that causes about half of an ischemic stroke.Carotid bifurcation atherosclerosis has a recognized role in the pathogenesis of cerebrovascular events,the main mechanism is rupture of carotid plaque.After endothelial injury,atherosclerotic plaque begins to form with pathological intimal thickening,one of the earliest detectable changes in atherosclerosis.To maintain lumen integrity,the blood vessels adaptively respond by dilating the vessel wall and increasing the plaque volume.Once this compensatory expansion exceeds the critical point,negative remodeling occurs and lumen stenosis occurs.This phase is accompanied by changes in the composition of the plaque.As the plaque volume increases,the proportion of lipids and calcification increases,making the plaque more fragile.Plaque rupture or erosion,luminal thrombosis and displacement,cerebral infarction occurs when embolizing the distal vascular network.Thyroid dysfunction has been thought to be closely related to an increase in vascular events.Patients with primary hypothyroidism are three times more likely to develop early atherosclerosis than normal risk factors,such as atherosclerotic lipid mass spectrometry,hypertension,and endothelial dysfunction.These are treated with levothyroxine.Patients have proven to be beneficial in reducing cardiovascular risk.Subclinical hypothyroidism(SCH)is a common endocrine subclinical disease,defined as elevated levels of serum thyroid stimulating hormone(TSH)and free thyroxine(FT4)and free three.The level of free triiodothyronine(FT3)is within the normal range.The prevalence of subclinical hypothyroidism is high,but relatively asymptomatic.This study was to investigate the association between SCH and atherosclerosis in patients with ischemic stroke and to analyze whether SCH is an independent risk factor for atherosclerosis in patients with acute ischemic stroke,in order to provide new clinical ideas for the prevention and treatment of ischemic stroke.Objective:The effect of subclinical hypothyroidism(SCH)on atherosclerosis is not clear.The aim of this study was to elucidate the relationship between SCH and carotid atherosclerosis.The China Stroke Association’s first report on stroke in China in 2015 shows that there are about 2.7 million new cerebrovascular disease patients in China each year,and about 1.3 million patients die of cerebrovascular disease every year.Every 12 seconds,there are people who have a stroke.Every 21 seconds,someone died of a stroke.Stroke is the first cause of death in China.The economic burden of stroke on China is as high as 40 billion yuan per year,and it is on the rise.Research evidence suggests that more than 80%of strokes can be prevented by controlling risk factors.Exploring the risk factors of stroke,effective primary prevention and secondary prevention of stroke are important measures to reduce the onset and death of stroke.Method:200 consecutive hospitalized patients with acute ischemic stroke within seven days of onset were divided into SCH group and non-SCH group.The general data of the two groups were compared.Carotid plaque and stenosis were assessed by carotid ultrasonography.There were 59 cases(29.5%)in plaque-free group and 141 cases(70.5%)in plaque-free group.There were 10 cases of carotid stenosis,including 4 cases of severe stenosis,3 cases of moderate stenosis and 3cases of mild stenosis.Univariate analysis and multivariate logistic regression analysis were used to evaluate the correlation between SCH and carotid atherosclerosis.Results:.There were significant differences in Sex ratio(x~2=5.769,P=0.016),baseline NIHSS score(z=-2.907,P=0.004),FT4(z=-2.055,P=0.041),TSH(z=-10.203),P<0.001)between SCH group and non-SCH group(P<0.05).There were significant differences in age(z=-3.182,P=0.001),diastolic blood pressure(z=-2.328,P=0.02),etiology of stroke(x~2=13.206,P=0.01),homocysteine(z=-2.033,P=0.042),TSH(z=-2.414,P=0.016),and SCH ratio(x~2=5.429,P=0.02)between plaque group and plaque-free group(P<0.05).There was significant difference in LDL-C(z=-2.294,P=0.023)between stenosis group and non-stenosis group(P<0.05).Multivariate stepwise logistic regression analysis.The results showed that age([odds ratio,OR]1.050,95%confidence interval(CI)1.016～1.085;P=0.004]),SCH([odds ratio,OR]1.351,95%confidence interval(CI)1.080～1.688;P=0.007])were independent risk factors for plaque.For every one year of age,the risk of plaque increases by 5%,and there is a risk of plaque in SCH.Compared with those without SCH,the increase was 1.351 times(P<0.05).Conclusion:Age and SCH are independent risk factors for carotid plaque in patients with ischemic stroke.