肾小球滤过率监测对急性缺血性脑卒中患者临床转归的评估价值

Evaluation value of clinical outcome in patients with acute ischemic stroke by glomerular filtration rate monitoring

目的探讨急性缺血性脑卒中患者肾小球滤过率(GFR)评估临床转归的价值。方法选取2019年1月至2021年1月江苏省宜兴市人民医院收治的96例急性缺血性脑卒中患者,根据出院后6个月时的改良Rankin量表(mRS)评分将其分为不良组(mRS评分≥3分,39例)和良好组(mRS评分<3分,57例)。比较两组入院时一般资料和实验室检查指标,对影响急性缺血性脑卒中患者转归的因素进行多因素分析,采用受试者操作特征(ROC)曲线分析GFR预测急性缺血性脑卒中患者转归的价值。结果不良组美国国立卫生研究院卒中量表(NIHSS)评分高于良好组,血尿酸、谷丙转氨酶、GFR均低于良好组(P<0.05)。多因素分析显示,NIHSS评分、血尿酸、GFR均是急性缺血性脑卒中患者转归情况的影响因素(P<0.05)。ROC曲线分析显示,GFR预测急性缺血性脑卒中患者转归情况的截断值为98.87 ml/(min·1.73m^(2)),灵敏度为84.62%,特异度为92.98%,曲线下面积为0.925(P<0.05)。结论急性缺血性脑卒中转归不良患者GFR异常降低,临床监测GFR可作为预测急性缺血性脑卒中患者转归不良的敏感指标。

Objective To explore the evaluation value of clinical outcome in patients with acute ischemic stroke by glomerular filtration rate(GFR).Methods A total of 96 patients with acute ischemic stroke admitted to Yixing People’s Hospital,Jiangsu Province from January 2019 to January 2021 were selected.According to the modified Rankin scale score at six months after discharged,they were divided into poor group(mRS score≥3 points,39 cases)and good group(mRS score<3 points,57 cases).The general data and laboratory indicators of the two groups at admission were compared,and the factors influencing the outcome of patients with acute ischemic stroke were analyzed by multivariate analysis,and the value of GFR in predicting the outcome of patients with acute ischemic stroke was analyzed by receiver operating characteristic(ROC)curve.Results The score of National Institutes of Health stroke scale(NIHSS)in the poor group was higher than that in the good group,and serum uric acid,glutamic-pyruvic transaminase,and GFR were lower than those in the good group(P<0.05).Multivariate analysis showed that scores of NIHSS,serum uric acid,and GFR were all influencing factors for the outcome of patients with acute ischemic stroke(P<0.05).ROC curve analysis showed that GFR had a cut-off value of 98.87 ml/(min·1.73m^(2)),a sensitivity of 84.62%,a specificity of 92.98%,and an area under curve of 0.925 in predicting the outcome of acute ischemic stroke patients(P<0.05).Conclusion The GFR of patients with poor outcome of acute ischemic stroke is abnormally reduced,clinical monitoring of GFR can be used as a sensitive indicator to predict the poor outcome of patients with acute ischemic stroke.