微量白蛋白尿与急性缺血性卒中的严重程度和转归的关系  

Relalionship between microaibuminuria and severity of acute ischemic stroke and outcomes

作　　者：孙永安[1] 何效兵[1] 郭振委[1] 陶爱华[1] 何明利[1] 

机构地区：[1]连云港市第一人民医院神经内科,222002

出　　处：《国际脑血管病杂志》2014年第8期590-595,共6页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨微量白蛋白尿（microalbuminuria，MAU）与急性缺血性卒中的危险因素、病情严重程度及转归的关系。方法前瞻性纳入连续的急性缺血性卒中患者，根据尿白蛋白／肌酐比率（urinealbumin／creatinineratio，UACR）分为MAU阳性组（〉130mg／g）和MAU阴性组（〈30mg／g），根据改良Rankin量表（modifiedRankinScale，mRS）评分分为转归良好组（0～2分）和转归不良组（〉2分），对各项人口统计学和临床资料进行比较，并分析急性缺血性卒中转归不良和MAU阳性的独立因素。结果共纳入156例急性缺血性卒中患者，其中男性84例，女性72例；年龄53—78岁，平均（65．4±6．2）岁；发病至入院时间为1．5—28h；94例转归良好，62例转归不良，无死亡病例；76例MAU阳性，80例MAU阴性。多变量logistic回归分析显示，高龄[优势比（oddsratio，OR）1．992，95％可信区间（confidence缸erval，C／）1．108～2．374；P=0．015]、合并糖尿病（OR2．497，95％C／1．177～5．298；P=0．017）和心房颤动（OR2．338，95％C／1．062～5．148；P=0．035）、高血清高半胱氨酸（homocysteine，I-Icy）水平（OR2．541，95％C／1．073～6．02；P=0．047）和UACR（OR2．130，95％C／1．396～3．017；P=0．001）、MAU阳性（OR3．291，95％C／1．681～6．444；P=0．001）、高基线美国国立卫生研究院卒中量表（Nati0砌InstitutesofHealthStrokeScale，NIHSS）评分（OR9．196，95％C／2。828～19．815；P〈0．001）是急性缺血性卒中患者转归不良的独立危险因素。MAU阳性组合并糖尿病的患者比例（P=0．038）以及空腹血糖水平（P=0．025）、血清Hcy水平（P=0．022）和颈动脉内膜一中膜厚度（intima-mediathickness，IMT）（P=0．019）与MAU阴性组存在显著性差异。MAU阳性组前循环梗死比例较低（P=0．033），基线NIHSS评分（P=0．003）和转归不良率较高（P〈0．001）。多变量logisObjective To investigate the relationship between microalbuminuria （MAU） and the risk factor for acute ischemic stroke, the severity of the disease and outcomes. Methods A total of 156 consecutive patients with acute ischemic stroke were enrolled prospectively. They were randomly divided into either an MAU positive group （≥ 30 mg/g） or an MAU negative group （ 〈 30 mg/g） according to urinary albumin/creatinine ratio （UACR）. They were also randomly divided into either a good outcome group （0 -2） or a poor outcome group （〉2） according to the modified Rankin scale （mRS） scores. The various demographic and clinical data were compared, and the poor outcome of acute ischemic stroke and the inde- pendent factors of positive MAU were analyzes.Results A total of 156 patients with acute ischemic stroke were enrolled, including 84 males and 72 female; aged 53 to 78 years （mean 65.4 ± 6. 2）; the time from on- set to admission was 1.5 to 28 h; 94 patients had good outcomes, 62 had poor outcomes, and no one died; MAU was positive in 76 patients and MAU was negative in 80 ones. Multivariate logistic regression analysis showed that advanced age （odds ratio [ OR] 1.992, 95% confidence interval [CI] 1. 108 - 2. 374; P = 0. 015）, complicated with diabetes （OR 2. 497, 95% CI 1. 177 -5.298; P =0. 017） and atrial fibrillation （OR 2. 338, 95% CI 1. 062 - 5. 148; P = 0. 035）, high serum homocysteine （Hcy） level （OR 2. 541, 95% CI 1. 073 - 6. 02; P = 0. 047） and UACR （OR 2. 130, 95 % CI 1. 396 - 3.017; P = 0. 001 ）, MAU positive （OR 3. 291, 95% CI 1. 681 -6. 444; P =0. 001）, high baseline National Institutes of Health Stroke Scale （NIHSS） score （OR 9. 196, 95% CI 2. 828- 19. 815; P〈 0. 001 ） were the independent risk factors for poor outcomes in patients with acute ischemic stroke. There were significant differences in the proportion of the patients complicated with diabetes （P =0. 038） and fasting blood glucose level （P =0. 025）, serum Hcy level （P =0

关 键 词：卒中 脑缺血 白蛋白尿 肌酐 动脉粥样硬化 疾病严重程度指数 治疗结果 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]