李敏;李昊;王友明;张蒙阁;

• 1:河北工程大学临床医学院
• 2:河北工程大学附属医院

摘要(Abstract)：

目的探讨甲状腺激素水平与卒中后疲劳(PSF)的关系。方法纳入2019-03—12在河北工程大学附属医院住院的脑卒中患者151例,依据疲劳严重程度量表(FSS)将患者分为PSF组(n=78)和非PSF组(n=73)。比较2组患者入院后第2天、第10天、1个月和3个月的甲状腺激素水平变化情况,并分析激素水平改变与PSF的关系。结果 PSF组和非PSF组各时间节点的甲状腺激素水平均有显著差异,其中PSF组促甲状腺素(TSH)和游离甲状腺素(FT4)水平均高于非PSF组,而游离三碘甲状腺原氨酸(FT3)水平均低于非PSF组,差异有统计学意义(P<0.05)。随着治疗时间的增加,患者疲劳症状改善且伴随FSS分值的减少,TSH和FT4水平也出现下降趋势,而FT3水平呈上升趋势。Pearson相关分析显示,TSH和FT4水平与FSS值呈正相关(r=0.712,P<0.01;r=0.529,P<0.05),FT3与FSS值呈负相关(r=-0.573,P<0.05)。结论甲状腺激素水平变化与PSF有相关性,且监测甲状腺激素水平变化对预估PSF的发生、发展及预后有一定的临床价值。

关键词(KeyWords)： 脑卒中;卒中后疲劳;甲状腺激素;促甲状腺素;游离甲状腺素;游离三碘甲状腺原氨酸

Abstract:

Keywords:

基金项目(Foundation): 2019年度河北省邯郸市科技局项目(编号:19422083011-14)

作者(Authors): 李敏;李昊;王友明;张蒙阁;

参考文献(References)：

• [1] ZHOU M,WANG H,ZENG X,et al.Mortality,morbidity,and risk factors in China and its provinces,1990-2017:a systematic analysis for the Global Burden of Disease Study 2017[J].Lancet,2019,394(10204):1145-1158.DOI:10.1016/S0140-6736(19)30427-1.
• [2] CUMMING T B,PACKER M,KRAMER S F,et al.The prevalence of fatigue after stroke:a systematic review and meta-analysis[J].Int J Stroke,2016,11(9):968-977.DOI:10.1177/1747493016669861.
• [3] JANG S H,LEE J,YEO S S.Central post-stroke pain due to injury of the spinothalamic tract in patients with cerebral infarction:a diffusion tensor tractography imaging study[J].Neural Regen Res,2017,12(12):2021-2024.DOI:10.4103/1673-5374.221159.
• [4] CUMMING T B,YEO A B,MARQUEZ J,et al.Investigating post-stroke fatigue:An individual participant data meta-analysis[J].J Psychosom Res,2018,113(6):107-112.DOI:10.1016/j.jpsychores.2018.08.006.
• [5] HINKLE J L,BECKER K J,KIM J S,et al.Poststroke Fatigue:Emerging Evidence and Approaches to Management:A Scientific Statement for Healthcare Professionals From the American Heart Association[J].Stroke,2017,48(7):e159-e170.DOI:10.1161/STR.0000000000000132.
• [6] POULSEN M B,SKOVB?LLING S L,KRUUSE C,et al.How to identify fatigue in stroke patients:an investigation of the post-stroke fatigue case definition validity[J].Top Stroke Rehabil,2019:1-8.DOI:10.1080/10749357.2019.1704387.
• [7] ALSOBAYEL H I,ALHUGAIL H A,ALSAIF R M,et al.Validation of an arabic version of Fatigue Severity Scale[J].Saudi Med J,2016,101(1):73-78.DOI:10.15537/smj.2016.1.13055.
• [8] BROUSSY S,ROUANET F,LESAINE E,et al.Post-stroke pathway analysis and link with one year sequelae in a French cohort of stroke patients:the PAPASePA protocol study[J].BMC Health Serv Res,2019,19(1):770.DOI:10.1186/s12913-019-4522-2.
• [9] DELVA M Y,DELVA I I,LYTVYNENKO N V.Post-stroke fatigue and its dimensions over the second half year after stroke[J].Wiad Lek,2018,71(2):314-317.
• [10] WEN H,WEYMANN K B,WOOD L,et al.Inflammatory Signaling in Post-Stroke Fatigue and Depression[J].Eur Neurol,2018,80(3):138-148.DOI:10.1159/000494988.
• [11] KLINEDINST N J,SCHUH R,KITTNER S J,et al.Post-stroke fatigue as an indicator of underlying bioenergetics alterations[J].J Bioenerg Biomembr,2019,51(2):165-174.DOI:10.1007/s10863-018-9782-8.
• [12] BUNEVICIUS A,IERVASI G,BUNEVICIUS R.Neuroprotective actions of thyroid hormones and low-T3 syndrome as a biomarker in acute cerebrovascular disorders[J].Expert Rev Neurother,2015,15:315-326.DOI:10.1586/14737175.2015.1013465.
• [13] CHEN X,DUAN L,HAN Y,et al.Predictors for vascular cognitive impairment in stroke patients[J].BMC Neurol,2016,16(1):115.DOI:10.1186/s12883-016-0638-8.
• [14] LANCT?T K L,LINDSAY M P,SMITH E E,et al.Canadian Stroke Best Practice Recommendations:Mood,Cognition and Fatigue following Stroke,6th edition update 2019[J].Int J Stroke,2019,1747493019847334.DOI:10.1177/1747493019847334.
• [15] NADARAJAH M,GOH H T.Post-stroke fatigue:a review on prevalence,correlates,measurement,and management[J].Top Stroke Rehabil,2015,22(3):208-220.DOI:10.1179/1074935714Z.0000000015.
• [16] 陈先辉,孙国平,徐芸,等.社区脑卒中患者疲劳与社会支持状况的相关性研究[J].中国实用神经疾病杂志,2016,19(5):1-2.
• [17] ACCIARRESI M,BOGOUSSLAVSKY J,PACIARONI M.Post-stroke fatigue:epidemiology,clinical characteristics and treatment[J].Eur Neurol,2014,72(5/6):255-261.DOI:10.1159/000363763.
• [18] 程弘禹,李丹,郑圆.急性脑梗死患者相关血液标志物水平及颈动脉内中膜厚度的研究[J].中国实用神经疾病杂志,2020,23(8):672-677.DOI:10.12083/SYSJ.2020.08.159.
• [19] CHEN K,MARSH E B.Chronic post-stroke fatigue:It may no longer be about the stroke itself[J].Clin Neurol Neurosurg,2018,174:192-197.DOI:10.1016/j.clineuro.2018.09.027.