不同肾功能水平的急性缺血性卒中患者血浆氧化低密度脂蛋白水平对患者预后的影响

Effect of Plasma Oxidized Low Density Lipoprotein on Prognosis in Acute Ischemic Stroke Patients with Different Levels of Renal Function

目的探讨急性缺血性卒中(acute ischemic stroke,AIS)伴有不同程度肾功能水平的患者功能预后与血浆氧化低密度脂蛋白(oxidized low-density lipoprotein,ox LDL)水平的相关性。方法本研究观察对象来自急性缺血性卒中患者氧化应激水平的临床观察研究(Study on Oxidative Stress in Patients with Acute Ischemic Stroke,SOS-Stroke)。采用酶联免疫吸附法(enzyme-linked immuno sorbent assay,ELISA)检测患者血浆ox LDL水平,通过计算得出的肾小球滤过率对患者进行分层,并在卒中发生后1年随访患者,评价改良Rankin量表(modified Rankin Scale,m RS)评分。分析不同肾功能水平患者中ox LDL与不良预后(m RS≥3分)的关系。结果本研究共纳入3284例患者,其中877(26.71%)例患者功能预后不良,根据肾功能分组后,正常组1241例,轻度异常组924例,中重度异常组242例,其中预后不良患者分别为正常组344(21.70%)例、轻度异常组371(28.65%)例和中重度异常组162(40.10%)例。在肾功能正常和轻度受损分组中,血浆ox LDL水平对患者1年后m RS评分有显著影响:肾功能正常组,ox LDL每增加一个标准差,m RS评分增加0.12分[比值比(odds ratio,OR)0.12,95%可信区间(confidence interval,CI)0.05～0.19,P=0.0009],预后不良风险增加20%(OR 1.20,95%CI 1.02～1.40,P=0.0271);肾功能轻度受损组,ox LDL每增加一个标准差,m RS评分增加0.16分(OR 0.16,95%CI 0.07～0.25,P=0.0007),预后不良风险增加21%(OR 1.21,95%CI 1.03～1.41,P=0.0190);但在肾功能中重度受损的分组中,血浆ox LDL水平并未对m RS评分产生显著影响。结论肾功能正常和轻度受损的急性缺血性卒中患者血浆ox LDL水平升高与卒中发病1年内不良预后率升高有关。

Objective To investigate the correlation between functional prognosis and plasma oxidized lowdensity lipoprotein（ox LDL） in acute ischemic stroke（AIS） patients with different levels of renal function.Methods All subjects were recruited from the Study of Oxidative Stress in Patients With Acute Ischemic Stroke（SOS-Stroke）.Plasma level of ox-LDL was measured by enzyme-linked immuno sorbent assay（ELISA）.Patients were stratified by the calculated glomerular filtration rate,and followed up at 1 year after stroke onset to assess the modified Rankin Scale（m RS） score.Analysis of the relationship between ox LDL and poor prognosis（modified Rankin scale ≥3 points） in patients with different levels of renal function were performed.Results A total of 3284 patients were enrolled in this study,of whom 877（26.71%） had poorfunctional outcomes.After grouping according to renal function,there were 1241 cases of normal control,924 cases of mild abnormality,and 242 cases of moderate-severe abnormality.Patients of poor prognosis in all groups were respectively 344（21.70%） cases of normal group,371（28.65%） cases of mild abnormal group,and 162 cases（40.10%） of moderate-severe abnormal group.The plasma level of ox LDL had a significant effect on 1-year m RS score in the patients with normal and mild damage renal function：in normal renal function group,the m RS score increased by 0.12 points for each standard deviation increase in ox LDL [OR 0.12,95%CI 0.05-0.19,P =0.0009],and the risk of poor prognosis increased by 20%（OR 1.20,95%CI 1.02-1.40,P =0.0271）;in mild renal impairment group,the m RS score increased by 0.16 points for each standard deviation increase in ox LDL.（OR 0.16,95%CI 0.07-0.25,P =0.0007）,and the risk of poor prognosis increased by 21%（OR 1.21,95%CI 1.03-1.41,P =0.0190）;however,in moderate-severe renal impairment group,plasma ox LDL levels did not significantly affect the m RS score.Conclusion The increased of plasma ox LDL levels in AIS patients with normal renal function and mild renal impairment are associated with the poor prognosis within 1 year.