Study on the Correlation and Predictive Significance of Endocrine Hormones along the HPT Axis with Poor Prognosis in Patients with Fatigue after Ischemic Stroke

WANG Zongwei; WANG Xiaobo; MA Ruiyan; YU Ke; ZHANG Yuanyuan

doi:10.3969/j.issn.1002-3429.2025.14.013

Abstract：Objective To explore the correlation and predictive significance between endocrine hormones along the hypothalamic-pituitary-thyroid(HPT)axis and the poor prognosis of patients with fatigue after ischemic stroke.Methods A total of 112 patients with post-stroke fatigue(PSF)admitted from January 2022 to January 2024 were selected as the observation group,and another 112 patients without fatigue after ischemic stroke during the same period were selected as the control group.The levels of endocrine hormones[triiodothyronine(T3),thyroxine(T4),free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH)]along the HPT axis were compared between the two groups.The observation group was followed up for 6 months and was divided into the good prognosis subgroup and the poor prognosis subgroup according to prognosis.The levels of endocrine hormones along the HPT axis in the two subgroups were compared.A two-column correlation analysis was used to analyze the correlation between endocrine hormones along the HPT axis and poor prognosis,and a multivariate logistic regression analysis was used to analyze the impact of endocrine hormones along the HPT axis on poor prognosis.The predictive value of endocrine hormones along the HPT axis for poor prognosis was evaluated by using the receiver operating characteristic(ROC)curve.Results There was no significant difference in the levels of serum T4 and FT4 between the two groups(P>0.05).The levels of serum T3 and FT3 in the observation group were lower than those in the control group,while the level of TSH was higher than that in the control group(P<0.01).The levels of serum T3 and FT3 in the poor prognosis subgroup were lower than those in the good prognosis subgroup,and the level of TSH was higher than that in the good prognosis subgroup(P<0.01).Two-column correlation analysis showed that serum T3 and FT3 were negatively correlated with poor prognosis in PSF patients(r=-0.708,-0.724,P<0.01),while TSH was positively correlated with poor prognosis in PSF patients(r=0.717,P<0.01).Multivariate logistic regression analysis showed that before and after adjusting for other factors,serum T3,FT3,and TSH were all independent influencing factors for poor prognosis in PSF patients(P<0.01).The ROC curve showed that the predictive value of serum T3,FT3,and TSH in combination for poor prognosis in PSF patients was significantly higher than that of individual indicators(P<0.01).Conclusion The dysfunction of the HPT axis in patients with PSF is mainly manifested as the decrease of serum T3 and FT3 and the increase of TSH,which is closely related to the risk of poor prognosis in patients,and the combined prediction of poor prognosis in patients has a good value.