尿蛋白与急性缺血性脑梗死预后的相关性研究

摘要

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 of 386 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≥ 5 at discharge were defined as good short-term prognosis,and those with a improved score of<5 were 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 225 males(70.5%),94 females (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 34 males(61.8%),21 females(38.2%),19(34.5%)younger than 65 years old,36(65.5%)older than 65 years old,46 patients(83.6%)with hypertension,26 patients(47.3%)with diabetes,73 patients(48.2%)with hyperlipi-demia and 31 patients(56.4%)with positive urine protein.Logistic regression analysis showed that patients at the age of over 65 years(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.Con-clusion Urinary protein suggests short-term adverse effects in patients with acute ischemic stroke.