急性缺血性脑卒中患者微量白蛋白尿影响因素及其对预后的影响研究

Influencing Factors of Microalbuminuria in Patients with Acute Ischemic Stroke and Its Influence on Prognosis

背景近年研究发现,急性脑卒中患者普遍存在微量白蛋白尿(MAU),且MAU可加重急性脑卒中患者神经功能缺损程度,因此MAU可能成为脑卒中潜在的治疗靶点。目的分析急性缺血性脑卒中(AIS)患者MAU的影响因素,并探讨其对患者预后的影响。方法选取2016年3月—2018年2月合肥市第三人民医院神经内科收治的急性缺血性脑卒中(AIS)患者150例,其中MAU阴性者60例(对照组),MAU阳性者90例(观察组)。比较两组患者一般资料(包括性别、年龄、收缩压及高血压、高脂血症发生情况)和实验室检查指标[包括总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、C反应蛋白(CRP)、同型半胱氨酸(Hcy)及空腹血糖(FPG)],AIS患者MAU影响因素分析采用多因素Logistic回归分析;所有患者随访6个月,比较两组患者治疗前及随访1、3、6个月美国国立卫生研究院卒中量表(NIHSS)评分,随访1、6个月卒中复发率及病死率。结果(1)两组患者性别、年龄及高血压发生率比较,差异无统计学意义(P>0.05);观察组患者收缩压及高脂血症发生率高于对照组(P<0.05)。(2)两组患者LDL水平比较,差异无统计学意义(P>0.05);观察组患者TC、TG、CRP、Hcy水平及FPG高于对照组,HDL水平低于对照组(P<0.05)。(3)多因素Logistic回归分析结果显示,高脂血症[OR=3.865,95%CI(1.362,10.965)]、TC[OR=4.577,95%CI(1.129,18.549)]、TG[OR=4.162,95%CI(1.470,11.784)]、HDL[OR=0.304,95%CI(0.112,0.827)]、Hcy[OR=4.679,95%CI(1.507,14.525)]及FPG[OR=3.589,95%CI(1.374,9.378)]是AIS患者MAU的独立影响因素(P<0.05)。(4)两组患者治疗前NIHSS评分比较,差异无统计学意义(P>0.05);随访1、3、6个月,观察组患者NIHSS评分低于对照组(P<0.05)。(5)两组患者随访1个月无一例患者卒中复发,两组患者随访6个月卒中复发率及随访1、6个月病死率比较,差异均无统计学意义(P>0.05)。结论高脂血症、TC、TG、HDL、Hcy及FPG是AIS患者发生MAU的独立影响因素,MAU可使AIS患者神经功能恢复变慢,但未增加卒中复发风险及病死率。

Background Recent studies found that,microalbuminuria(MAU)is prevalent in patients with acute stroke,moreover MAU can aggravate the degree of neurological impairment,that may become a potential therapeutic target for stroke.Objective To analyze the influencing factors of MAU in patients with acute ischemic stroke(AIS)and its influence on prognosis.Methods A total of 150 hospitalized patients diagnosed as AIS admitted to the Department of Neurology,the Third People’s Hospital of Hefei from March 2016 to February 2018 were selected and divided into control group(with positive MAU,n=60)and observation group(with negative MAU,n=90).General information(including gender,age,systolic blood pressure,incidence of hypertension and hyperlipidemia)and laboratory examination results(including TC,TG,HDL,LDL,CRP,Hcy and FPG)were compared between the two groups;multivariate Logistic regression analysis was used to analyze the influencing factors of MAU in patients with AIS.All of the 150 patients were followed up for 6 months,NIHSS score before treatment,1 month,3 months and 6 months after follow-up,recurrence rate of stroke and fatality rate 1 month and 6 months after follow-up were compared between the two groups.Results(1)There was no statistically significant difference in gender,age or incidence of hypertension between the two groups(P>0.05);systolic blood pressure and incidence of hyperlipidemia in observation group were statistically significantly higher than those in control group(P<0.05).(2)There was no statistically significant difference in LDL level between the two groups(P>0.05);levels of TC,TG,CRP,Hcy and FPG in observation group were statistically significantly higher than those in control group,while HDL level in observation group was statistically significantly lower than that in control group(P<0.05).(3)Multivariate Logistic regression analysis results showed that,hyperlipidemia[OR=3.865,95%CI(1.362,10.965)],TC[OR=4.577,95%CI(1.129,18.549)],TG[OR=4.162,95%CI(1.470,11.784)],HDL[OR=0.304,95%CI(0.112,0.827)],Hcy[OR=4.679,95%CI(1.507,14.525)]and FPG[OR=3.589,95%CI(1.374,9.378)]were independent influencing factors of MAU in patients with AIS(P<0.05).(4)There was no statistically significant difference in NIHSS score between the two groups before treatment(P>0.05);1 month,3 months and 6 months after follow-up,NIHSS score in observation group was statistically significantly lower than that in control group(P<0.05).(5)There was no recurrence of stroke in the two groups 1 month after follow-up.There was no statistically significant difference in recurrence rate of stroke 6 months after follow-up,or fatality rate 1 month or 6 months after follow-up between the two groups(P>0.05).Conclusion Hyperlipidemia,TC,TG,HDL,Hcy and FPG are independent factors of MAU in patients with AIS,and MAU can slow the recovery of neurological function,but it does not increase the risk of stroke recurrence and mortality.