Low and high circulating cortisol levels predict mortality and cognitive dysfunction early after stroke
Low and high circulating cortisol levels predict mortality and cognitive dysfunction early after stroke
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DOI：
10.1111/j.1365-2796.2004.01334.x
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发表时间：
2004-07-01
影响因子：
11.1
通讯作者：
Olsson, T
中科院分区：
文献类型：
--
作者：
Marklund, N;Peltonen, M;Olsson, T
Objective.皮质醇水平升高与脑卒中后意识模糊和预后不良有关。硫酸脱氢表雄酮（DS）是最丰富的肾上腺雄激素，可作为抗糖皮质激素。这些类固醇的调节改变可能会影响许多脑功能，包括神经元存活。本研究的目的是调查中风后早期血清皮质醇和DS水平以及皮质醇/DS比值，并将我们的发现与定向障碍和死亡率的存在联系起来。急性缺血性卒中患者（n = 88，56名男性和32名女性）入院卒中单元进行了调查，重复的临床评估和评分的混乱程度，轻瘫程度和功能水平。在第1天和/或第4天测量血清皮质醇（C）和DS。提供了28天和1年死亡率的数据。使用65名年龄匹配的健康个体作为对照组。采用Logistic回归分析对不同三分位或六分位血清皮质醇水平的死亡率进行多因素分析，调整年龄、性别、糖尿病和意识水平。与对照组相比，中风患者第1天的血清皮质醇水平无差异。急性定向障碍组的皮质醇水平显著高于定向障碍组（P < 0.05）。第1天的皮质醇水平是28天死亡率的独立预测因子，皮质醇水平低（550 nmol L-1）的患者1年死亡率均增加。脑卒中患者第1天的DS水平显著升高。皮质醇增多症与缺血性卒中后早期认知功能障碍相关。高和低循环皮质醇水平与中风后死亡率增加有关。DS水平与临床结局无关。
Objective. Elevated cortisol levels are associated with confusion and poor outcome after stroke. Dehydroepiandrosterone sulphate (DS), the most abundant adrenal androgen may act as an anti-glucocorticoid. An altered regulation of these steroids may affect numerous brain functions, including neuronal survival. The purpose of this study was to investigate serum cortisol and DS levels and the cortisol/DS ratio early after stroke and relate our findings to the presence of disorientation and mortality.Design. Patients with acute ischaemic stroke (n = 88, 56 men and 32 women) admitted to a stroke unit were investigated with repeated clinical assessments and scores for degree of confusion, extent of paresis and level of functioning. Serum cortisol (C) and DS were measured on day 1 and/or day 4. Data for 28-day and 1-year mortality are presented. A control group of 65 age-matched healthy individuals was used. Multivariate analyses of mortality rates in the different tertiles or sixtiles of serum cortisol were performed with logistic regression, adjusting for age, sex, diabetes and level of consciousness.Results. There was no difference in serum cortisol levels on day 1 for stroke patients when compared with control group values. Initial cortisol levels were significantly higher in the patients with acute disorientation versus orientated patients (P < 0.05). Cortisol levels on day 1 were an independent predictor of 28-day mortality, and patients with low cortisol levels (550 nmol L-1) both had an increased 1-year mortality. DS levels on day 1 were significantly elevated in stroke patients.Conclusion. Hypercortisolism is associated with cognitive dysfunction early after ischaemic stroke. High and low circulating cortisol levels are associated with increased mortality after stroke. DS levels were not associated with clinical outcome.