Abstract: Background　Parathyroid hormone （PTH） levels are related to the occurrence of various cardiovascular diseases，but there are few studies on the relationship with the severity and prognosis of ischemic stroke. Objective　To explore the relationship between the level of PTH in middle-aged and elderly people and the severity and prognosis of ischemic stroke. Methods　A total of 79 middle-aged and elderly patients with acute CIS who satisfied the inclusion criteria and were treated in the First Affiliated Hospital of Xi'an Medical University from 2018-04-01 to 2018-10-01 were selected as the case group，and a total of 65 patients with non-cerebral infarction and physical examination who were treated in the First Affiliated Hospital of Xi'an Medical University during the same period were selected as the control group. The general data and PTH，vitamin D （VD），interleukin 6 （IL-6） levels on the first admission day of all study subjects were collected，the neurological deficit of the case group was assessed by National Institute of Health Stroke Scale （NIHSS），the cerebral infarct area of the case group was measured and calculated，and the Modified Rankin Scale （MRS） was used to evaluate the recovery of neurological function in the case group at 1 month of onset. Results　Binary Logistic regression analysis showed that diastolic blood pressure 〔OR=0.904，95%CI（0.866，0.942）〕，PTH 〔OR=0.878，95%CI （0.793，0.972） 〕，IL-6 〔OR=0.566，95%CI （0.381，0.842）〕 were the influencing factors of ischemic stroke in the middle-aged and elderly people （P < 0.05）. Pearson's correlation analysis showed that there was no linear correlation between PTH and IL-6 levels （r=-0.300，P=0.794） and there was a negative correlation with VD （r=-0.266，P=0.018） in patients with acute ischemic stroke. There was a statistically significant difference in PTH among patients with acute ischemic stroke in different areas of cerebral infarction and recovery of neurological function （P<0.05）； There was no statistically significant difference in PTH among acute ischemic stroke patients with different neurological deficits （P>0.05）. Spearman rank correlation analysis showed that PTH in patients with acute ischemic stroke is negatively correlated with cerebral infarction area （rs=-0.261，P=0.020） and neurological function recovery （rs=-0.291，P=0.009），uncorrelated with neurological deficit （rs=-0.025，P=0.830） in patients with acute ischemic stroke. Conclusion　Diastolic blood pressure，PTH and IL-6 were the influencing factors of ischemic stroke in middle-aged and elderly patients，PTH in middle-aged and elderly patients with acute ischemic stroke is negatively correlated with cerebral infarction area and neurological function recovery.

Key words: Stroke, Ischemic stroke, Parathyroid hormone, Middle aged, Aged, Severity of illness, Prognosis, Root cause analysis

摘要： 背景　甲状旁腺素（PTH）水平与多种心血管疾病的发生有关，但与缺血性脑卒中严重程度及预后关系的研究尚少。目的　探究中老年人PTH水平与缺血性脑卒中严重程度及预后的关系。方法　选取2018-04-01至2018-10-01在西安医学院第一附属医院就诊的符合纳入标准的中老年急性缺血性脑卒中患者79例作为病例组，并选取同期于西安医学院第一附属医院就诊的非脑梗死者和体检者共65例为对照组。收集所有研究对象一般资料及入院第1天PTH、维生素D（VD）、白介素6（IL-6）水平，采用美国国立卫生院神经功能缺损量表（NIHSS）评估病例组神经功能缺损情况，测量并计算病例组脑梗死面积，采用改良Rankin量表（mRS）评分评估病例组发病1个月时神经功能恢复状况。结果　二元Logistic回归分析结果显示，舒张压〔OR=0.904，95%CI（0.866，0.942）〕、PTH〔OR=0.878，95%CI（0.793，0.972）〕、IL-6〔OR=0.566，95%CI（0.381，0.842）〕是中老年人发生缺血性脑卒中的影响因素（P<0.05）。Pearson相关分析结果显示：急性缺血性脑卒中患者PTH和IL-6水平（r=-0.300，P=0.794）无直线相关关系，与VD呈负相关（r=-0.266，P=0.018）。不同脑梗死面积、神经功能恢复状况急性缺血性脑卒中患者PTH比较，差异有统计学意义（P<0.05）；不同神经功能缺损情况急性缺血性脑卒中患者PTH比较，差异无统计学意义（P>0.05）。Spearman秩相关分析结果显示：急性缺血性脑卒中患者PTH与脑梗死面积（rs=-0.261，P=0.020）、神经功能恢复情况（rs=-0.291，P=0.009）呈负相关，与神经功能缺损情况无相关关系（rs=-0.025，P=0.830）。结论　舒张压、PTH、IL-6是中老年人发生缺血性脑卒中的影响因素，且中老年急性缺血性脑卒中患者PTH与脑梗死面积、神经功能恢复情况呈负相关。　

关键词: 卒中, 缺血性卒中, 甲状旁腺素, 中年人, 老年人, 疾病严重程度, 预后, 影响因素分析