急性缺血性卒中患者血管内治疗成功再通术后低白蛋白血症:危险因素和对转归的影响  

Postoperative hypoalbuminemia in patients with acute ischemic stroke with successful recanalization by endovascular therapy: risk factors and their impact on outcomes

作　　者：卢浩 郭强[1] 郝永楠[1] 杨冬旭[1] 陈亚男 朱治 李雪源 Lu Hao;Guo Qiang;Hao Yongnan;Yang Dongxu;Chen Ya’nan;Zhu Zhi;Li Xueyuan(Department of Acute Stroke,the Affiliated Hospital of Jining Medical University,Jining 272000,China)

机构地区：[1]济宁医学院附属医院急诊卒中科,济宁272000

出　　处：《国际脑血管病杂志》2023年第10期721-727,共7页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨前循环大血管闭塞(large vessel occlusion, LVO)所致急性缺血性卒中(acute ischemic stroke, AIS)患者血管内机械血栓切除术(endovascular mechanical thrombectomy, EMT)后发生低白蛋白血症(hypoalbuminemia, HA)的危险因素及对转归的影响。方法回顾性纳入2020年6月1日至2023年4月31日在济宁医学院附属医院急诊卒中科首次确诊为前循环LVO-AIS并急诊行EMT的患者。根据术后(6~8 d)首次复查血清白蛋白, 将患者分为HA组(<35 g/L)和非HA组(≥35 g/L)。根据EMT后90 d时改良Rankin量表评分, 将患者分为转归良好组(0~2分)和转归不良组(3~6分)。应用单变量和多变量logistic分析确定EMT后HA的独立危险因素及其对转归的影响。结果共纳入144例患者, 男性107例(74.30%), 年龄中位数64岁(四分位数间距56~71岁);HA组50例(34.72%), 非HA组94例(65.28%);转归良好组60例(41.67%), 转归不良组84例(58.33%)。多变量logistic回归分析显示, 年龄[优势比(odds ratio,OR)1.061, 95%置信区间(confidence interval,CI)1.014~1.111;P=0.011]和肺部感染(OR 5.136, 95%CI 1.917~13.760;P=0.001)是HA的独立危险因素;HA(OR 4.345, 95%CI 1.367~13.814;P=0.013)、肺炎(OR 5.113, 95%CI 1.217~12.528;P=0.026)和发病至再灌注时间(OR 5.473, 95%CI 1.090~16.005;P=0.038)是转归不良的独立危险因素。结论年龄和肺部感染是LVO-AIS患者EMT后发生HA的独立危险因素, 而且HA是患者转归不良的独立危险因素。Objective To investigate the risk factors of hypoalbuminemia(HA)in patients with acute ischemic stroke(AIS)caused by large vessel occlusion(LVO)after endovascular mechanical thromboectomy(EMT)and impact on outcomes.Methods Patients first diagnosed with anterior circulation LVO-AIS and underwent emergency EMT at the Department of Acute Stroke,the Affiliated Hospital of Jining Medical University from June 1,2020 to April 31,2023 were retrospectively included.According to the first follow-up serum albumin examination after procedure(6-8 d),the patients were divided into HA group(<35 g/L)and non-HA group(≥35 g/L).According to the modified Rankin Scale score at 90 d after EMT,the patients were divided into a good outcome group(0-2)and a poor outcome group(3-6).Univariate and multivariate logistic analysis was used to determine independent risk factors for HA after EMT and their impact on outcomes.Results A total of 144 patients were enrolled,including 107 males(74.30%)with a median age of 64 years(interquartile range,56-71 years).There were 50 patients(34.72%)in the HA group and 94(65.28%)in the non-HA group;60(41.67%)in the good outcome group,and 84(58.33%)in the poor outcome group.Multivariate logistic regression analysis showed that age(odds ratio[OR]1.061,95%confidence interval[CI]1.014-1.111;P=0.011)and pulmonary infection(OR 5.136,95%CI 1.917-13.760;P=0.001)were independent risk factors for HA;HA(OR 4.345,95%CI 1.367-13.814;P=0.013),pneumonia(OR 5.113,95%CI 1.217-12.528;P=0.026),and onset to reperfusion time(OR 5.473,95%CI 1.090-16.05;P=0.038)were independent risk factors for poor outcomes.Conclusions Age and pulmonary infection are independent risk factors for HA in LVO-ASI patients after EMT,and HA is the independent risk factor for poor outcomes of the patients.

关 键 词：缺血性卒中 血管内治疗 血栓切除术 血清白蛋白 低白蛋白血症 危险因素 治疗结果 

分 类 号：R651.1[医药卫生—外科学]