CAJ | 학술논문

目的探讨血清Mg2+浓度与急性缺血性脑卒中患者短期预后的关系,为改善其预后提供合理依据.方法以2006年1月1日至2008年12月30日在山东省4家医院住院急性缺血性脑卒中患者为调查对象,收集人口统计学、生活方式、疾病史、血生化指标、入院血压水平等资料.研究结局定义为出院的脑卒中量表评分(NIHSS)≥10分或者死亡.按NIHSS(NIH卒中评分)将研究对象分为两组,即死亡/NIHSS≥10及NIHSS＜10组.血清Mg2+浓度按四分位数分为4个水平.采用Cox比例风险模型分析血清Mg2+浓度与急性缺血性脑卒中患者短期预后的关系.结果死亡/NIHSS≥10组的血清Mg2+浓度、发病至入院时间低于NIHSS＜ 10组(P＜0.05)；入院时收缩压水平高于NIHSS＜ 10组(P＜0.05)；低密度脂蛋白胆固醇异常、空腹血糖受损及心房纤颤史的百分率均高于NIHSS＜ 10组(P＜0.05).单因素分析发现血清Mg2+浓度第4分位(最高水平)可以降低急性缺血性脑卒中患者发生死亡/NIHSS≥10的危险性(RR=0.47,P＜0.05)；调整血清Ca2+、K+水平等其他因素后,血清Mg2+第4分位和第3分位水平均可降低发生死亡/NIHSS≥10的危险性(RR值分别为0.39和0.54,P＜0.05).无论是否调整其他因素,血清Mg2+浓度与发生死亡/NIHSS≥10的危险性均存在着剂量反应关系(趋势检验P＜0.05).结论高浓度的血清Mg2+可降低急性缺血性脑卒中患者发生死亡/NIHSS≥10的危险性,并存在剂量反应关系.
목적 탐토혈청Mg2+농도여급성결혈성뇌졸중환자단기예후적관계,위개선기예후제공합리의거.방법 이2006년1월1일지2008년12월30일재산동성4가의원주원급성결혈성뇌졸중환자위조사대상,수집인구통계학、생활방식、질병사、혈생화지표、입원혈압수평등자료.연구결국정의위출원적뇌졸중량표평분(NIHSS)≥10분혹자사망.안NIHSS(NIH졸중평분)장연구대상분위량조,즉사망/NIHSS≥10급NIHSS＜10조.혈청Mg2+농도안사분위수분위4개수평.채용Cox비례풍험모형분석혈청Mg2+농도여급성결혈성뇌졸중환자단기예후적관계.결과 사망/NIHSS≥10조적혈청Mg2+농도、발병지입원시간저우NIHSS＜ 10조(P＜0.05)；입원시수축압수평고우NIHSS＜ 10조(P＜0.05)；저밀도지단백담고순이상、공복혈당수손급심방섬전사적백분솔균고우NIHSS＜ 10조(P＜0.05).단인소분석발현혈청Mg2+농도제4분위(최고수평)가이강저급성결혈성뇌졸중환자발생사망/NIHSS≥10적위험성(RR=0.47,P＜0.05)；조정혈청Ca2+、K+수평등기타인소후,혈청Mg2+제4분위화제3분위수평균가강저발생사망/NIHSS≥10적위험성(RR치분별위0.39화0.54,P＜0.05).무론시부조정기타인소,혈청Mg2+농도여발생사망/NIHSS≥10적위험성균존재착제량반응관계(추세검험P＜0.05).결론 고농도적혈청Mg2+가강저급성결혈성뇌졸중환자발생사망/NIHSS≥10적위험성,병존재제량반응관계.
Objective To explore the relationship between the concentration of serum magnesium and the short-term outcome of patients with acute ischemic stroke,in order to provide evidence for improving the outcomes.Methods Patients with acute ischemic stroke under study,were from four hospitals in Shandong province.Data on demographic characteristics,life style related risk factors,history of cardiovascular disease,blood pressure at admission and other clinical characteristics were collected for all the participants.The outcomes were defined as National Institutes of Health Stroke Scale (NIHSS) ≥ 10 or death.According to NIHSS,the subjects were divided into two groups:death/NIHSS≥ 10 and NIHSS＜ 10.Concentrations of Mg2+ were categorized into four levels according to the quartiles of serum magnesium.Cox proportion hazard regression analysis was used to evaluate the association between serum magnesium concentrations and the short-term outcome of acute ischemic stroke.Results In the death/NIHSS≥10 group,concentrations of serum magnesium and the time from onset to admission were lower than that in the NIHSS＜ 10 group while the systolic blood pressure on admission,the proportion of low density lipoprotein abnormal,impaired fasting glucose and history of auricular fibrillation were all higher than that in the NIHSS＜ 10 group.Without the adjustment of multiple factors,when comparing to the lowest quartile of serum magnesium level,the fourth quartile (highest) seemed to have had a tendency of reducing the risk of death/NIHSS ≥ 10 (RR=0.47,P＜ 0.05).When multiple factors were adjusted (adjust serum calcium,potassium level and other factors),the fourth and the third quartiles could both reduce the risk of death/ NIHSS≥10 (RR values were 0.39 and 0.54,P＜0.05,respectively).With or without the adjustment of multiple factors,there appeared a dose-response relationship between serum magnesium concentrations and the risk to death/ NIHSS≥10 (trend P＜0.05).Conclusion Higher serum magnesium concentrations could reduce the risk to death/NIHSS ≥ 10,suggesting that there was a dose-response relationship between magnesium and the risk to death/NIHSS ≥ 10.