血尿素氮/肌酐比值和尿比重与急性脑梗死静脉溶栓预后的相关性研究

Correlation between Blood Ureanitrogen/Creatinine Ratio and Urine Specific Gravity and Prognosis of Patients with Acute Cerebral Infarction after Intravenous Thrombolysis

目的测定急性脑梗死患者溶栓前血尿素氮/肌酐（BUN/Cr）比值及尿比重,探讨其与静脉溶栓预后的关系。方法选取2014年12月—2015年9月急性脑梗死静脉溶栓患者121例,根据静脉溶栓治疗后第90日改良Rankin量表（mRS）评分分为预后良好组（mRS评分：0~2）72例及预后不良组（mRS评分：3~6）49例。以BUN/Cr≥15和尿比重〉1.010同时作为脱水指标,分析其与临床预后的关系。结果经单因素分析显示与预后不良相关的因素有：入院时美国国立卫生院脑卒中量表评分、尿素氮、尿比重、BUN/Cr比值、脱水状态、房颤病史、甘油三酯、血糖、同型半胱氨酸、总蛋白水平、白蛋白水平（P〈0.05,P〈0.01）。多因素Logistic回归分析提示脱水状态、房颤病史和白蛋白水平均是预后不良的独立危险因素（P〈0.01）。结论本研究显示以BUN/Cr≥15和尿比重〉1.010作为脱水状态指标可预测急性脑梗死静脉溶栓临床预后,尽快纠正脱水状态可能会改变其远期预后。

Objective To detect blood urea nitrogen/creatinine（ BUN/Cr） ratio and urine specific gravity（ USG） and to investigate the correlations between BUN/Cr and USG and prognosis of patients with acute cerebral infarction（ ACI） after intravenous thrombolysis. Methods A total of 121 ACI patients after intravenous thrombolysis during December 2014 and September 2015 were divided into good outcome group（ 0-2 of mRS score,n = 72） and poor outcome group（ 3-6mRS of score,n = 49） according to modified Rankin scale（ mRS） score on the 90 thd after intravenous thrombolysis. The BUN / Cr ratio equal or over 15 and USG value over 1. 010 were used as markers of relative dehydration,and the relationships between BUN / Cr and USG and prognosis were analyzed. Results The single factor analysis showed that related factors of unfavourable prognosis were the National Institutes of Health Stroke Scale（ NIHSS） score,urea nitrogen,USG,BUN / Cr ratio,dehydration condition,fibrillation atrial history and levels of triglyceride,blood glucose,homocysteic acid,total protein level and albumin（ P〈0. 05,P〈0. 01）. The multivariate logistic regression analysis showed that markers of relative dehydration,and fibrillation atrial history and albumin level were independent risk factors of unfavourable prognosis（ P〈0. 01）. Conclusion BUN / Cr ratio equal or over 15 and USG value over 1. 010 as markers of relative dehydration can predict clinical prognosis of ACI patients after intravenous thrombolysis,and long-term prognosis may be improved through treating the dehydration condition.