血清前白蛋白降低对急性脑梗死患者住院期间死亡的预测

Serum prealbumin level as a predictor of in-hospital death of acute ischemic stroke patients

目的观察急性脑梗死患者发病早期血清生化及血常规指标与住院期间死亡的关系。方法回顾性分析发病72 h内就诊的急性脑梗死患者1089例,根据出院时存活状态分为死亡组(36例)和存活组(1053例)。记录患者年龄、性别、首次静脉血清生化指标(白蛋白,前白蛋白,肌酐)和血常规指标(血球压积,血红蛋白)。结果与存活组比较,死亡组患者年龄、肌酐水平明显增高,白蛋白、前白蛋白、血球压积和血红蛋白明显降低,差异有统计学意义(P<0.01)。随白蛋白水平降低,患者死亡率明显增加,差异有统计学意义(P<0.01)。随前白蛋白水平降低,患者死亡率明显增加,差异有统计学意义(P<0.01)。logistic回归分析表明,住院期间死亡与血清前白蛋白(OR=1.276,95%CI:1.196～1.361,P<0.01)以及肌酐(OR=0.991,95% CI:0.987～0.995,P<0.01)密切相关。结论血清前白蛋白水平下降可以预测急性脑梗死患者住院期间死亡。

Objective To observe the association of the serum biochemical and blood routine indexes measured within 72 h after stroke and in-hospital mortality in patients with acute ischemic stroke. Methods One thousand and eighty-nine consecutive patients with acute ischemic stroke were retrospectively analyzed. Serum biochemical indexes including albumin, prealbumin and creatinine level,and blood routine indexes including hemoglobin and hematocrit at admission were reviewed. Age,gender,and rehabilitation outcome（alive or died） were analyzed. Thirty-six patients died in hospital in total. Results Mean age in death group was significantly higher than that in live group （P 〈 0.01）. The mortality rate was significantly higher in patients with lower serum albumin and prealbumin than in patients with higher ones （P 〈 0.01）. Patients died in hospital had significantly lower serum albumin, prealbumin, Hb, Hct level and significantly higher creatinine level than patients survived （P 〈 0.01）. Logistic regression analysis showed that mortality was associated with decreased prealbumin level （OR = 1. 276,95% CI： 1. 196-1. 361, P〈0.01） and elevated creatinine level （OR = 0. 991,95% CI ： 0. 987-0. 995, P〈 0.01）. Conclusions Relatively low serum prealbumin level in acute ischemic stroke patients increases the risk of in-hospital mortality.