国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2014年
8期
590-595
,共6页
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
卒中%腦缺血%白蛋白尿%肌酐%動脈粥樣硬化%疾病嚴重程度指數%治療結果%危險因素
졸중%뇌결혈%백단백뇨%기항%동맥죽양경화%질병엄중정도지수%치료결과%위험인소
Stroke%Brain Ischemia%Albuminuria%Creatinine%Atherosclerosis%Severity of Illness Index%Treatment Outcome%Risk Factors
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(urine albumin/creatinine ratio,UACR)分为MAU阳性组(≥30 mg/g)和MAU阴性组(＜30 mg/g),根据改良Rankin量表(modified Rankin Scale,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1.5～28 h;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(odds ratio,OR)1.992,95％可信区间(c onfidence interval,CI)1.108～2.374;P=0.015]、合并糖尿病(OR 2.497,95％ CI1.177～5.298;P =0.017)和心房颤动(OR 2.338,95％ CI1.062 ～5.148;P=0.035)、高血清高半胱氨酸(homocysteine,Hcy)水平(OR 2.541,95％ CI 1.073～6.02;P=0.047)和UACR(OR 2.130,95％ CI1.396 ～3.017;P =0.001)、MAU阳性(OR 3.291,95％ CI1.681 ～6.444;P=0.001)、高基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分(OR9.196,95％ CI2.828～19.815;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-中膜厚度(intima-media thickness,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logistic回归分析显示,合并糖尿病(OR 2.237,95％ CI1.036 ～4.829;P =0.040)以及空腹血糖(OR 1.223,95％ CI1.145 ～1.673;P=0.027)和Hcy水平(OR 2.542,95％ CI 1.047～6.612;P=0.025)、颈动脉IMT(OR1.295,95％ CI1.106 ～1.362;P=0.023)和基线NIHSS评分(OR1.206,95％ CI1.044 ～1.219;P =0.023)增高与急性缺血性卒中患者MAU阳性独立相关.结论 MAU阳性是急性缺血性卒中转归不良的独立危险因素之一,且与急性缺血性卒中的部分危险因素密切相关,并对急性缺血性卒中病情严重程度和转归有着显著的影响.
目的 探討微量白蛋白尿(microalbuminuria,MAU)與急性缺血性卒中的危險因素、病情嚴重程度及轉歸的關繫.方法 前瞻性納入連續的急性缺血性卒中患者,根據尿白蛋白/肌酐比率(urine albumin/creatinine ratio,UACR)分為MAU暘性組(≥30 mg/g)和MAU陰性組(＜30 mg/g),根據改良Rankin量錶(modified Rankin Scale,mRS)評分分為轉歸良好組(0～2分)和轉歸不良組(＞2分),對各項人口統計學和臨床資料進行比較,併分析急性缺血性卒中轉歸不良和MAU暘性的獨立因素.結果 共納入156例急性缺血性卒中患者,其中男性84例,女性72例;年齡53～ 78歲,平均(65.4±6.2)歲;髮病至入院時間為1.5～28 h;94例轉歸良好,62例轉歸不良,無死亡病例;76例MAU暘性,80例MAU陰性.多變量logistic迴歸分析顯示,高齡[優勢比(odds ratio,OR)1.992,95％可信區間(c onfidence interval,CI)1.108～2.374;P=0.015]、閤併糖尿病(OR 2.497,95％ CI1.177～5.298;P =0.017)和心房顫動(OR 2.338,95％ CI1.062 ～5.148;P=0.035)、高血清高半胱氨痠(homocysteine,Hcy)水平(OR 2.541,95％ CI 1.073～6.02;P=0.047)和UACR(OR 2.130,95％ CI1.396 ～3.017;P =0.001)、MAU暘性(OR 3.291,95％ CI1.681 ～6.444;P=0.001)、高基線美國國立衛生研究院卒中量錶(National Institutes of Health Stroke Scale,NIHSS)評分(OR9.196,95％ CI2.828～19.815;P ＜0.001)是急性缺血性卒中患者轉歸不良的獨立危險因素.MAU暘性組閤併糖尿病的患者比例(P=0.038)以及空腹血糖水平(P=0.025)、血清Hcy水平(P=0.022)和頸動脈內膜-中膜厚度(intima-media thickness,IMT)(P=0.019)與MAU陰性組存在顯著性差異.MAU暘性組前循環梗死比例較低(P=0.033),基線NIHSS評分(P=0.003)和轉歸不良率較高(P＜0.001).多變量logistic迴歸分析顯示,閤併糖尿病(OR 2.237,95％ CI1.036 ～4.829;P =0.040)以及空腹血糖(OR 1.223,95％ CI1.145 ～1.673;P=0.027)和Hcy水平(OR 2.542,95％ CI 1.047～6.612;P=0.025)、頸動脈IMT(OR1.295,95％ CI1.106 ～1.362;P=0.023)和基線NIHSS評分(OR1.206,95％ CI1.044 ～1.219;P =0.023)增高與急性缺血性卒中患者MAU暘性獨立相關.結論 MAU暘性是急性缺血性卒中轉歸不良的獨立危險因素之一,且與急性缺血性卒中的部分危險因素密切相關,併對急性缺血性卒中病情嚴重程度和轉歸有著顯著的影響.
목적 탐토미량백단백뇨(microalbuminuria,MAU)여급성결혈성졸중적위험인소、병정엄중정도급전귀적관계.방법 전첨성납입련속적급성결혈성졸중환자,근거뇨백단백/기항비솔(urine albumin/creatinine ratio,UACR)분위MAU양성조(≥30 mg/g)화MAU음성조(＜30 mg/g),근거개량Rankin량표(modified Rankin Scale,mRS)평분분위전귀량호조(0～2분)화전귀불량조(＞2분),대각항인구통계학화림상자료진행비교,병분석급성결혈성졸중전귀불량화MAU양성적독립인소.결과 공납입156례급성결혈성졸중환자,기중남성84례,녀성72례;년령53～ 78세,평균(65.4±6.2)세;발병지입원시간위1.5～28 h;94례전귀량호,62례전귀불량,무사망병례;76례MAU양성,80례MAU음성.다변량logistic회귀분석현시,고령[우세비(odds ratio,OR)1.992,95％가신구간(c onfidence interval,CI)1.108～2.374;P=0.015]、합병당뇨병(OR 2.497,95％ CI1.177～5.298;P =0.017)화심방전동(OR 2.338,95％ CI1.062 ～5.148;P=0.035)、고혈청고반광안산(homocysteine,Hcy)수평(OR 2.541,95％ CI 1.073～6.02;P=0.047)화UACR(OR 2.130,95％ CI1.396 ～3.017;P =0.001)、MAU양성(OR 3.291,95％ CI1.681 ～6.444;P=0.001)、고기선미국국립위생연구원졸중량표(National Institutes of Health Stroke Scale,NIHSS)평분(OR9.196,95％ CI2.828～19.815;P ＜0.001)시급성결혈성졸중환자전귀불량적독립위험인소.MAU양성조합병당뇨병적환자비례(P=0.038)이급공복혈당수평(P=0.025)、혈청Hcy수평(P=0.022)화경동맥내막-중막후도(intima-media thickness,IMT)(P=0.019)여MAU음성조존재현저성차이.MAU양성조전순배경사비례교저(P=0.033),기선NIHSS평분(P=0.003)화전귀불량솔교고(P＜0.001).다변량logistic회귀분석현시,합병당뇨병(OR 2.237,95％ CI1.036 ～4.829;P =0.040)이급공복혈당(OR 1.223,95％ CI1.145 ～1.673;P=0.027)화Hcy수평(OR 2.542,95％ CI 1.047～6.612;P=0.025)、경동맥IMT(OR1.295,95％ CI1.106 ～1.362;P=0.023)화기선NIHSS평분(OR1.206,95％ CI1.044 ～1.219;P =0.023)증고여급성결혈성졸중환자MAU양성독립상관.결론 MAU양성시급성결혈성졸중전귀불량적독립위험인소지일,차여급성결혈성졸중적부분위험인소밀절상관,병대급성결혈성졸중병정엄중정도화전귀유착현저적영향.
Objective 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 independent 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 onset 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 fibrilhtion (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 Hey level (P =0.022),and carotid intima-media thickness (IMT) (P =0.019) between the MAU positive group and the MAU negative group.The proportion of anterior circulation infarction was lower (P =0.033),the rates of the baseline NIHSS score (P =0.003) and poor outcome were higher in the MAU positive group (P ＜ 0.001).Multivariate logistic regression analysis showed that increased diabetes (OR 2.237,95％ CI 1.036-4.829; P =0.040) and fasting blood glucose (OR 1.223,95％ CI 1.145-1.673; P =0.027),the increased Hey level (OR 2.542,95％ CI 1.047-6.612; P=0.025),carotid artery IMT (OR 1.295,95％ CI 1.106-1.362; P =0.023) and baseline NIHSS score (OR1.206,95％ CI 1.044-1.219; P =0.023) were correlated independently with the positive MAU in patients with acute ischemic stroke.Conclusions Positive MAU is one of the independent risk factors for poor outcomes of acute ischemic stroke,it is closely associated with some risk factors for acute ischemic stroke,and it has a significant impact on the severity of acute ischemic stroke and outcomes.
