尿蛋白与急性缺血性脑梗死预后的相关性研究

Study on the relationship between urinary protein and prognosis of acute ischemic cerebral infarction

目的探讨尿蛋白与急性缺血性脑梗死(acute ischemic stroke,AIS)患者短期预后的相关性。方法连续收集2015-08—2016-08民航总医院住院诊断为AIS患者386例(后期排除12例),回顾分析其入院后尿蛋白水平、入院及出院时生活活动量表(ADL)得分。其中出院较入院评分改善≥5分者定义为短期预后改善,评分<5分者定义为短期预后不良。采用Logistic回归方法分析尿蛋白与所评价的预后功能之间的相关性。结果本研究374例患者中,预后改善319例,其中男225例(70.5%),女94例(29.5%);年龄≤65岁151例(47.3%),>65岁168例(52.7%);高血压238例(74.6%),糖尿病128例(40.1%),高血脂274例(85.9%),尿蛋白阳性者119(37.3%)。预后未改善55例,其中男34例(61.8%),女21例(38.2%);年龄≤65岁19例(34.5%),>65岁36例(65.5%);高血压46例(83.6%),糖尿病26例(47.3%),高血脂73例(48.2%),尿蛋白阳性31例(56.4%)。通过Logistic回归分析显示,年龄>65岁(P=0.016)、尿蛋白阳性者(P=0.009)急性缺血性脑梗死患者短期预后较差,提示尿蛋白是急性缺血性脑梗死患者短期预后不良的独立危险因素。结论尿蛋白提示急性缺血性脑梗死患者短期预后不良。

Objective To determine if there was an association of stroke recurrence with proteinuria.Methods A total of386 consecutive patients with acute ischemic stroke(AIS)were admitted to hospital from August 2015 to August 2016.Urinary protein level and ADL scores at admission and at discharge were reviewed.Patients with a improved score of≥5at discharge were defined as good short-term prognosis,and those with a improved score of<5were classified as poor short-term prognosis.Logistic regression was used to analyze the correlation between proteinuria and the evaluated prognostic function.Results A total of 374 patients were enrolled in this study.Among them,319 patients had improved prognosis,including 225males(70.5%),94females(29.5%),151(47.3%)younger than 65 years old,168(52.7%)older than 65 years old,238(74.6%)with hypertension,128(40.1%)with diabetes,274(85.9%)with hyperlipidemia and 119(37.3%)with urine protein positive.There were 55 patients with poor prognosis,including 34males(61.8%),21females(38.2%),19(34.5%)younger than 65 years old,36(65.5%)older than 65 years old,46patients(83.6%)with hypertension,26patients(47.3%)with diabetes,73patients(48.2%)with hyperlipidemia and 31patients(56.4%)with positive urine protein.Logistic regression analysis showed that patients at the age of over 65years(P =0.016)and those with positive urinary protein(P =0.009)had a poorer short-term prognosis with acute ischemic stroke.Proteinuria and age were independent risk factors of poor short-term prognosis in patients with acute ischemic stroke.Conclusion Urinary protein suggests short-term adverse effects in patients with acute ischemic stroke.