急性脑梗死静脉溶栓后早期神经功能恶化与血清白蛋白水平的关系研究

摘要

Objective To illustrate the relationships between the serum albumin level and early neurological deterioration (END) after the intravenous thrombolysis in patients with acute cerebral infarction. Methods The clinical data were collected from 148 patients (within 4.5 h of onset) who received the intravenous thrombolytic therapy with alteplase from January 2017 to August 2018. According to the presence or absence of END, the patients were divided into deteriorating group and non-deteriorating group. The relationship among serum albumin level and END was analyzed by univariate and multivariate analysis. Results A total number of 148 patients were enrolled in this study, among whom 39 patients were in deterioration group and 109 patients were in the non-deterioration group. The total protein level, the albumin level and lymphocyte count were lower in deteriorating group as compared to those in the non-deteriorating group (P < 0.05), and the neutrophil count, red blood cell distribution width, international standardized ratio, fibrinase degradation products and National Institute of Health stroke scale (NIHSS) score at admission were higher in the deteriorating group (P < 0.05). Atrial fibrillation was more common in deteriorating group, and there were significance differences in the degree of stenosis and infarct location between the two groups (P < 0.05). Multivariate Logistic regression analysis showed that serum albumin level ( OR=0.873, 95% CI 0.768-0.993), score at admission ( OR= 1.120, 95% CI 1.008-1.245), neutrophil count ( OR=1.271, 95% CI 1.048-1.542), and the degree of cardiogenic stroke and responsible vessel stenosis may affect the short-term prognosis of acute ischemic stroke AIS after the intravenous thrombolysis. The Modified Rankin Scale (mRS) score (average 14 d) was negatively correlated with albumin level (r=-0.205, P=0.013). Conclusions Albumin level is a risk factor for END in patients with acute ischemic stroke. The albumin level of the deteriorating group is lower than that of the non-deteriorating group. The lower the albumin level,the higher the mRS score, the worse the prognosis.%目的 探讨急性脑梗死静脉溶栓后早期神经功能恶化(END)与血清白蛋白水平的关系.方法 收集2017年1月至2018年8月发病4.5 h内接受阿替普酶静脉溶栓治疗患者的临床资料.根据是否出现END,分为恶化组和非恶化组,分析血清白蛋白水平与END发生的相关性.结果 共纳入148例患者,其中恶化组39例,非恶化组109例.与非恶化组相比,恶化组总蛋白水平、白蛋白水平和淋巴细胞计数较低,且差异有统计学意义(P＜0.05).恶化组的中性粒细胞计数、红细胞分布宽度、国际标准化比值、纤维蛋白(原)降解产物以及入院时美国国立卫生研究院卒中量表(NIHSS)评分高于非恶化组,差异有统计学意义(P＜0.05).恶化组多伴有心房颤动,且两组在血管狭窄程度及梗死部位方面比较差异也有统计学意义(P＜0.05).多因素Logistic回归分析显示,血清白蛋白(OR=0.873,95% CI 0.768~0.993)、入院时NIHSS评分(OR=1.120,95% CI 1.008~1.245)、中性粒细胞计数(OR=1.271,95% CI 1.048~1.542),以及心源性卒中和责任血管狭窄程度均可能影响急性脑梗死静脉溶栓的短期预后.出院时改良Rankin量表(mRS)评分(平均14 d)与白蛋白水平呈显著负相关(r=—0.205,P=0.013).结论 相比于非恶化患者,恶化患者的白蛋白水平较低.高水平的血清白蛋白是急性缺血性脑卒中静脉溶栓后END的保护因素.血清白蛋白水平与患者的短期预后存在相关性,白蛋白水平越低,mRS评分越高,预后越差.