LI Hong,MA Jiang, SHI Wan-Ying, TAO Xiao-Lin, ZHANG Jun, MEI Hao-Nan, YANG Lei, GUO Zheng-Rong. Correlation between Thyroid Hormones Level and Cognitive Function in Convalescent Stroke Patients[J]. Chinese Journal of Stroke, 2021, 16(05): 482-486.
[1] SUN J H,TAN L,YU J T. Post-stroke cognitiveimpairment:epidemiology,mechanisms andmanagement[J]. Ann Transl Med,2014,2(8):80.[2] JOKINEN H,MELKAS S,YLIKOSKI R,et al.Post-stroke cognitive impairment is common evenafter successful clinical recovery[J]. Eur J Neurol,2015,22(9):1288-1294.[3] CHEN X L,DUAN L H,HAN Y F,et al. Predictors知功能损害组,且T3、FT3水平低于无认知功能损害组;患者血清T3、FT3水平与MMSE评分呈正相关,提示在正常值范围内,T3、FT3水平越低则认知功能损害越重。分析原因可能是卒中作为临床应激事件,一方面使下丘脑-垂体-甲状腺轴功能紊乱,直接导致T 3、F T 3水平降低;另一方面可破坏血脑屏障,减少上皮细胞的有机阴离子转运多肽水平,引起脑内T3下降[3]。相关研究发现T3对神经系统的生物学作用高于T4[4,20 -21],且T3水平降低将影响患者脑部血供、能量代谢及信号传导,导致弥漫性神经功能障碍,引起认知损害[12,22-23]。此外,大脑皮质、海马等区域损害将直接影响认知功能,而这些区域也是脑内甲状腺激素发挥生物学作用的主要区域,这些区域的损伤可能抑制甲状腺激素生物学作用的发挥,进一步加重认知功能损害。综上所述,卒中恢复期患者认知功能损害的发生率较高,且与甲状腺激素T3、FT3降低有关。因此,在卒中恢复期应常规检测甲状腺激素水平,并积极关注认知功能,尽早给予患者全面的认知康复治疗措施。本研究尚存在以下局限性:①本研究样本量较小,需扩大样本量深入探究认知功能与甲状腺激素水平的相关性;②本研究只应用MMSE初步评估患者认知功能,不能全面反映具体认知损害情况;③本研究为横断面研究,未对纳入人群进行干预和随访。因此,未来需进行大样本的前瞻性研究,进一步探究卒中恢复期患者认知功能与甲状腺激素水平的相关性。for vascular cognitive impairment in stroke s[J/OL].BMC Neurol,2016,16:115[2020-12-01]. https://doi.org/10.1186/s12883-016-0638-8.[4] JIANG X J,XING H Y,WU J,et al. Prognosticvalue of thyroid hormones in acute ischemicstroke-a meta analysis[J]. Sci Rep,2017,7(1):16256.[5] LAMBA N Y,LIU C M,ZAIDI H S,et al. Aprognostic role for low tri-iodothyronine syndromein acute stroke patients:a systematic review andmeta-analysis[J/OL]. Clin Neurol Neurosurg,2018,169:55-63[2020-12-01]. https://doi.org/10.1016/j.clineuro.2018.03.025.[6] 杜超,王昀,赵越,等. 甲状腺激素对皮质下缺血性血管病患者认知功能的影响[J]. 中国医药科学,2018,8(1):145-148.[7] QUINLAN P,HORVATH A,WALLIN A,et al. Lowserum concentration of free triiodothyronine(FT3)is associated with increased risk of Alzheimer’sdisease[J/OL]. Psychoneuroendocrinology,2019,99:112-119[2020-12-01]. https://doi.org/10.1016/j.psyneuen.2018.09.002.[8] 毛蕾,李澎,陈晓晗,等. 血清Aβ(1-42)、tau蛋白及甲状腺激素水平对缺血性卒中后认知障碍发生的预测价值[J]. 中国神经精神疾病杂志,2019,45(7):385-389.[9] 中华神经科学会,中华神经外科学会. 脑卒中患者临床神经功能缺损程度评分标准(1995)[J]. 中华神经科杂志,1996,29(6):381-383.[10] 宋希福,刘敏. 不良生活习惯对甲状腺结节的影响[J]. 中西医结合心血管病杂志,2017,5(29):182.[11] OU C Y,LI C L,AN X L,et al. Assessment ofcognitive impairment in patients with cerebralinfarction by MMSE and MoCA scales[J]. J CollPhysicians Surg Pak,2020,30(3):342-343.[12] 朱霖,田学隆. 基于认知再学习疗法的脑卒中康复治疗系统的设计及临床试验[J]. 中国生物医学工程学报,2015,34(6):757-762.[13] RENJEN P N,GAUBA C,CHAUDHARI D.Cognitive impairment after stroke[J/OL]. Cureus,2015,7(9):e335[2020-12-01]. https://doi.org/10.7759/cureus.335.[14] 徐俊,王伊龙. 血管性认知障碍研究的突破口:《卒中后认知障碍专家共识》解读[J]. 中国实用内科杂志,2018,38(2):69-71.[15] CALZÀ L,FERNÁNDEZ M,GIARDINO L. Roleof the thyroid system in myelination and neuralconnectivity[J]. Compr Physiol,2015,5(3):1405-1421.[16] NASREDDINE Z S,PHILLIPS N A,BÉDIRIAN V,et al. The montreal cognitive assessment,MoCA:a brief screening tool for mild cognitive impairment[J].J Am Geriatr Soc,2005,53(4):695-699.[17] 马瑞敏,刘竞争,郑光辉,等. 脑血管疾病患者血清甲状腺激素水平检测的临床意义[J]. 标记免疫分析与临床,2017,24(12):1321-1323.[18] DHITAL R,POUDEL D R,TACHAMO N,etal. Ischemic stroke and impact of thyroid profile atpresentation:a systematic review and meta-analysisof observational studies[J]. J Stroke Cerebrovasc Dis,2017,26(12):2926-2934.[19] GUSSEKLOO J,VAN EXEL E,DE CRAEN A J,etal. Thyroid status,disability and cognitive function,and survival in old age[J]. JAMA,2004,292(21):2591-2599.[20] WANG Y P,ZHOU S J,BAO J H,et al. Low T3levels as a predictor marker predict the prognosis ofpatients with acute ischemic stroke[J]. Int J Neurosci,2016,127(7):559-566.[21] BUNEVICIUS A,IERVASI G,BUNEVICIUSR. Neuroprotective actions of thyroid hormonesand low-T3 syndrome as a biomarker in acutecerebrovascular disorders[J]. Expert Rev Neurother,2015,15(3):315-326.[22] NIJSSE B,VISSER-MEILY J M,VAN MIERLOM L,et al. Temporal evolution of poststrokecognitive impairment using the montreal cognitiveassessment[J]. Stroke,2016,48(1):98-104.[23] HAINSWORTH A H,ALLAN S M,BOLTZE J,et al. Translational models for vascular cognitiveimpairment:a review including larger species[J].BMC Med,2017,15(1):16-25.