ABSTRACT
Objective:To investigate the predictive value of thyroid stimulating hormone (TSH) levels on short-term outcome after intravenous thrombolysis in patients with acute ischemic stroke.Methods:From January 2016 to June 2019, patients with acute ischemic stroke receiving intravenous alteplase in the Department of Neurology, Jinshan Branch of Shanghai Sixth People's Hospital were enrolled retrospectively. The National Institutes of Health Stroke Scale (NIHSS) was used to assess the degree of baseline neurological deficits. The modified Rankin Scale was used for short-term outcome evaluation at 14 d after onset. 0-2 was defined as good outcome and >2 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent risk factors for poor short-term outcomes. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of thyroid stimulating hormone on short-term prognosis of patients with acute ischemic stroke. Results:A total of 90 patients with acute ischemic stroke received intravenous thrombolysis were enrolled. Their age was 70.08±9.76 years, and 49 (54.44%) were male. The median NIHSS score before thrombolysis was 11.00 (interquartile range, 5.00-16.00). Forty-eight patients (53.33%) had good short-term outcomes, and 42 (46.67%) had poor short-term outcomes. Multivariate logistic regression analysis showed that after adjusting for confounding factors, severe neurological deficits at admission (severe stroke vs. mild stroke: odds ratio [ OR] 9.390, 95% confidence interval [ CI] 2.015-43.764; P=0.004) and low levels of TSH (the 2nd quartile vs. 4th quartile: OR 5.999, 95% CI 1.038-34.657, P=0.045; the 1st quartile vs.4th quartile: OR 6.525, 95% CI 1.107-38.469, P=0.038) were the independent predictors of poor short-term outcome after intravenous thrombolysis in patients with acute ischemic stroke. The ROC curve analysis showed that the area under the curve of TSH for predicting poor outcomes was 0.682 (95% CI 0.572-0.793; P=0.003). The best cutoff value was 1.695 mIU/L, the sensitivity was 76.19%, and the specificity was 60.42%. Conclusion:The decreased serum TSH is an independent predictor of poor short-term outcome after intravenous thrombolysis in patients with acute ischemic stroke.
ABSTRACT
It is well established that neural stem cells (NSCs) are not randomly distributed throughout the brain, but rather are concentrated around blood vessels. Although NSCs lie in a vascular niche, there is no direct evidence for a functional relationship between the NSCs and blood vessel component cells. It is reported that endothelial cells release soluble factors that stimulate the self-renewal of NSCs, inhibit their differentiation, and enhance their neuron production. Endothelial coculture can activate Notch to promote self-renewal. Furthermore, vascular endothelial growth factor (VEGF) plays a significant role in neural cells; it stimulates the growth and differentiation of astrocytes in the central nervous system (CNS). Therefore, beyond their traditional role as structural components of blood vessels, endothelial cells are not only critical component of the neural stem cell niche, but they also are able to enhance neurogenesis, possibly through the secretion of brain-derived neurotrophic factor.