脑梗死患者微量白蛋白尿的发生率及相关因素

Prevalence and related factors of microalbuminuria in patients with cerebral infarction

目的研究急性脑梗死患者微量白蛋白尿(MAU)的发生率、与卒中危险因素及脑梗死复发的关系。方法采用前瞻性病例对照研究,入选78例急性脑梗死患者;有脑梗死危险因素者56例;健康人28例作对照。用放射免疫法测定早晨第1次尿中白蛋白。尿中白蛋白小于20mg/L为正常白蛋白尿,在20～200mg/L为MAU,大于200mg/L为大量白蛋白尿。结果急性脑梗死患者35%有MAU,是有脑梗死危险因素者(15%)的2.3倍,健康人组3.5%有MAU(P<0.001)。存在6个独立预测MAU的危险因素,分别是糖尿病、冠心病、血白蛋白水平、年龄、高血压及HDL-C。随访1.5±0.9年,急性脑梗死组23%、脑梗死危险因素组12%再发血管意外,而健康人组无1例发生(P<0.005)。急性脑梗死组中有MAU者36%再发血管意外,有大量白蛋白尿者41%再发血管意外,而正常白蛋白尿者仅10%再发血管意外(P<0.05)。调整糖尿病、高血压后,MAU是卒中复发独立的预测指标。结论急性脑梗死患者MAU较常见。MAU是脑梗死复发的独立危险因素。提示MAU是既易检测又便宜的预测脑梗死的指标。

Objective To assess the prevalence of microalbuminuria(MAU) in patients with recent cerebral infarction and its associations to risk factors for stroke and recurrence.Methods Prosective case-control study was adopted.A total of 162 older men and women who were enrolled in a prosective study of risk factors for recurrent stroke,including 78 patients with recent cerebral infaction,56 with similar clinical risk factors for stroke,and 28 healthy control.Results MAU was 2 time more prevalent in patients with recent cerebral infaction(35%) than in those with clinical risk factors for stroke(15%),and was 3.5% in healthy elderly controls (P<0.001).The presence of MAU was predicted by diabetes,serum albumin levels,age,ischemic heart disease,hypertension and HDL-C.During 1.5±0.9 years of follow-up,23% of patients with recent cerebral infaction,12% with risk factors for stroke,and 0% of healthy elderly volunteers had vascular end points (P<0.005),with events being as frequent in patients with MAU(36%) as in patients with microalbuminuria(41%).After controlling for major clinical risk factors,MAU remained an independently significant predictor of future stroke. Conclusion MAU is a common finding in patients with cerebal infaction and is associated with increased risk for stroke.These data suggest that MAU merits further examination as potentially inexpensive and easily measured marker of increased risk for stroke.