急性缺血性卒中患者血清白蛋白水平对早期预后的影响

The implication of serum albumin level on the early prognosis in patients with acute ischemic stroke.

目的 探讨缺血性卒中患者入院时血清白蛋白水平对脑卒中早期预后 ,包括神经功能缺损、日常生活能力以及死亡率的影响。同时分析导致低血清白蛋白的危险因素。方法 收集发病 7d以内的缺血性脑卒中患者 ,记录包括各种危险因素在内的病史、体征以及住院过程中死亡等情况。在入院和出院时均采用欧洲卒中评分(EuropeanStrokeScale ,ESS)和Barthel生活指数 (BarthelIndex ,BI)进行临床神经功能和生活自理能力的评定 ,所有患者均在入院后 4 8h内检查血清白蛋白水平。采用出院时的ESS和BI作为评价患者早期预后的主要指标。结果 2 19例缺血性脑卒中患者入选 ,2 9例 (13 2 % )患者发现血清白蛋白低于 35g/L。入院时血清白蛋白低于 35g/L的患者ESS明显低于正常白蛋白组 (5 0 93vs70 0 4 ,P <0 0 0 1) ,出院时ESS和BI两组之间亦有明显差异 (5 2 6 6vs75 4 8,P <0 0 0 1;4 2 34vs 73 78,P <0 0 0 1) ,出院时两组患者死亡率亦不同 (10 3%vs 4 2 % ) ,但无统计学意义 (P =0 15 9)。Logistic回归分析发现年龄、入院距发病时间、吞咽困难和意识障碍是影响患者血清白蛋白水平的独立因素。结论 脑卒中患者入院时低血清白蛋白可能导致患者的早期神经功能差 ,生活能力低 ,死亡率高 ,是影响患者早期预后的独立?

Objective To investigate the relation between the serum albumin level on admission and the early prognosis in patients with acute ischemic stroke. And to analyze the risk factors for low serum albumin level among these patients. Methods Ischemic stroke patients hospitalized in our hospital were recruited in our study. European Stroke Scale (ESS) and Barthel Index (BI) were recorded at both the admission and discharge time. ESS and BI at the discharge time were used to evaluate the neurological function and ability of in dependent life. Serum albumin was examined within 48 hours after admission. Results 219 patients were enrolled in our study among whom 29 patients were found with low serum albumin level (35 g/L). The patients with low albumin level on the admission had low ESS and BI at the discharge(52.66 vs 75.48,P<0.001; 42.34 vs 73.78,P<0.001). The mortality during hospitalization in the patients with low serum albumin was higher than in those with normal albumin level (10.3% versus 4.2%), but the difference was not statistically significant. With multivariate logistic regression, age, delay after onset, dysphagia and unconsciousness were found to be the independent risk factors for low serum albumin level in the patients with ischemic stroke. Conclusions The low level of serum albumin in patients with ischemic stroke on admission may indicate the poorer outcome and higher mortality at discharge. Elder age, delay of admission, dysphagia and unconsciousness may be the risk factors for the low serum albumin level. Among patients with acute ischemic stroke, nutritional status should be taken into consideration.