微量白蛋白尿对急性脑梗死患者早期预后的影响  

Impact of microalbuminuria on the early prognosis of acute cerebral infarction early prognosis

作　　者：瞿萍[1] 陈贵海[2] 高宗良[1] 夏兰[1] 

机构地区：[1]安徽医科大学第二附属医院神经内科,安徽合肥230601 [2]安徽医科大学附属巢湖医院神经内科,安徽巢湖238000

出　　处：《中风与神经疾病杂志》2015年第11期1008-1012,共5页Journal of Apoplexy and Nervous Diseases

摘　　要：目的探讨微量白蛋白尿(MAU)对急性脑梗死患者的早期预后是否有影响。方法随机选取安徽医科大学第二附院神经内科住院急性脑梗死患者130例,用免疫比浊法测量患者的24 h尿白蛋白,根据有无MAU分为两组。用美国国立卫研究院卒中量表(NIHSS)评分表示神经功能缺损程度,用改良的Rankin量表(mRS)评分表示残疾程度。于发病48 h内和治疗后14 d时对患者进行NIHSS评分和mRS评分。比较两组患者神经系统缺损的程度是否有差别。mRS≤2分为残疾较轻,表示预后好,mRS>2分为残疾较重,表示预后差。应用二元逻辑回归分析来探讨MAU对神经功能预后的影响。结果入院时两组的神经功能缺损并无明显差异(Z=-1.566,P=0.117),MAU阳性的急性脑梗死患者治疗后的的神经功能缺损明显重于MAU阴性的患者(Z=-2.878,P=0.004)。尿中白蛋白的含量与发病时NIHSS评分(rs=0.175,P=0.046)和治疗后14 d时NIHSS评分(rs=0.393,P=0.004)均呈正相关。应用偏相关分析控制入院时NIHSS评分分析尿白蛋白与出院时NIHSS的相关性,结果显示尿白蛋白量与出院时NIHSS评分依然呈正相关(rs=0.194,P=0.027)。MAU阳性患者的预后较MAU阴性患者差,主要表现在无变化的患者较多(χ2=8.614,P=0.004),而进步的患者较少(χ2=8.893,P=0.002)。二元逻辑回归分析显示MAU阳性患者预后差的风险要高于MAU阴性患者3.073倍(P=0.025)。结论MAU与急性脑梗死患者神经功能缺损程度相关,是急性脑梗死患者预后差的独立危险因素。Objective To explore the effect of microalbuminuria（ MAU） on the early prognosis of the acute cerebral infarction. Methods We selected 130 patients with acute cerebral infarction randomly. Urinary albumin in the 24 h samples was assessed quantitatively by an immunonephelometric method. We conducted the National Institutes of Health Stroke Scale（ NIHSS） and the modified Rankin Scale score（ mRS） within 48 hours and 14 days after the cerebral infarction onset to understand the severity of stroke and the degree of disability. We divided the patients into two groups by the presence or absence of MAU and compared the NIHSS score of the two groups. A favorable outcome was defined as a mRS score of 0 -2 and a poor outcome as a mRS score 2. Binary logistic regression analysis was used to calculate odds ratios for the occurrence of poor outcome parameters. Results The NIHSS of patients in the two groups have had no significant difference at onset（ Z =-1. 566,P = 0. 117）,but patients with MAU presented more severity of stroke at 14 days after treatment（ Z=-2. 878,P = 0. 004）. The correlation analysis showed that the level of MAU was positive correlated with NIHSS score after treatment（ rs = 0. 393,P = 0. 004）. The patients with MAU had the poor outcome,mainly reflected in patients with no change（ χ2= 8. 614,P = 0. 004） and improvement（ χ2= 8. 893,P = 0. 002）. The Multionmial Logistic analysis showed MAU was an independent predictor of poor outcome（ OR： 3. 073,P = 0. 025）. Conclusion The presence of MAU was correlated with the severity of acute cerebral infarction. MAU was an independent predictor of poor outcome of acute cerebral infarction.

关 键 词：急性脑梗死 微量白蛋白尿 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]