The Prediction Effects Of Thyroid Function In The Short-term Prognosis In Patients With Subacute Combined Degeneration Of Spinal Cord

Objective:The purpose of this research is to explore the influence of thyroid function on the short-term prognosis of those with subacute combined degeneration of the spinal cord（SCD）,as well as to evaluate the predictive power of the functional disability rating scale score（FDS score）in conjunction with thyroid function for poor short-term prognosis of SCD.Methods:This study analyzed the data of SCD patients who visited the department of Neurology,The First Hospital of Jilin University for the first time during the time from January 2021 to December 2022,including the clinical data,clinical symptoms,laboratory tests(blood routine,folic acid,vitamin B₁₂,serum homocysteine levels,blood lipids,blood uric acid,fasting glucose,hypersensitivity C-reactive protein,glycated hemoglobin,thyroid function),neuroelectrophysiological findings,lumbar puncture findings,and imaging findings.The severity of neurological deficits was evaluated at admission according to FDS score and the prognosis recovery 3 months after discharge was assessed with modified Rankin scale（m RS score）.The enrolled subjects were split into two groups based on thyroid function:those with normal thyroid function（control group）and those with hypothyroidism（case group）.A comparison was made between the general data,clinical features,ancillary test results,FDS score,and m RS score.Additionally,SCD patients were also classified into good prognosis group（m RS score≤2）and poor prognosis group（m RS score>2）.A comparison was made between the general data,thyroid function,ancillary test results and FDS score.Then,univariate analysis of factors influencing poor prognosis of patients with SCD were examined by independent samples t-test（Measurement data of normal distribution）or Mann-Whitney test（Measurement data of non-normal distribution）of Chi.square test（Qualitative data）.And the significant factors identified on the univariate analysis were subjected to the multivariate analysis using the binary logistic regression analysis to clarify the independent risk factors.Lastly,ROC curve was employed to explore the suitable index of predicting short-term poor prognosis in SCD patients.Results:1.In our study,there are 28 cases in the normal thyroid function group and 12cases in the hypothyroidism group.Compared with normal thyroid function group,hypothyroidism group showed significantly statistical difference（P<0.05）on folic acid（10.64±6.58ng/m L vs 18.08±7.00ng/m L）,mean corpuscular hemoglobin concentration（MCHC）（339.81±11.36g/L vs 355.57±20.17g/L）and m RS score（1.88±0.99 vs 3.14±1.22）.2.In this study,there are 25 cases in the good prognosis group and 15 cases in the poor prognosis group.There were statistical differences in having a history of gastrointestinal disease（4.0%vs 40.0%）,the thyrotropin（TSH）（2.55±1.70m IU/L vs6.92±5.93m IU/L）,folic acid（16.43±6.39 ng/m L vs 10.93±6.94ng/m L）and functional disability rating scale score（FDS score）（5.65±1.34 vs 8.30±2.11）at admission between the poor prognosis group and the good prognosis group（P<0.05）.3.The results of binary logistic regression analysis showed that elevated TSH level[OR=2.152,95%confidence interval（95%CI）:1.050～4.411,P=0.036]and high FDS score（OR=5.573,95%CI:1.020～30.438,P=0.047）at admission were independent risk factors for a 3-month poor prognosis of SCD.4.There were results obtained by ROC calculation:TSH serum level at5.265m IU/L was the best cut-off value,with an area under curve（AUC）of 0.739（95%CI:0.529～0.949,P<0.001）,sensitivity of 60.0%and specificity of 95.7%;FDS score at admission at 7.5 was the best cut-off value for predicting the severity of SCD,with an area under curve（AUC）of 0.861（95%CI:0.717～1.000,P=0.031）,sensitivity of 70.0%and specificity of 95.7%.A 0.978 area was found to be the result of a combination of FDS score at admission and TSH serum levels（95%CI:0.937～1.000,P<0.001）,with sensitivity about 100.0%and specificity of 91.3%.The above results showed that the combination of these two indicators can more accurately predicate the risk of poor prognosis in SCD patients.Conclusion:1.Elevated TSH serum levels have correlation with the poor short-term prognosis of SCD.Likewise,hypothyroidism can provide an important basis for assessing the severity of the disease and judging its clinical prognosis.2.Both FDS score at admission and TSH serum levels are predictive of the occurrence of poor prognosis in SCD patients,and the combination of these two indicators can more accurately predict the risk of poor prognosis in SCD patients.