摘要
目的探讨血清前白蛋白与非心源性复发脑梗死的相关性,为二级预防提供依据。方法将2016-08/2018-06月于山东大学附属济南市中心医院神经内科急性脑梗死住院患者1063例分为初发组(n=663)和复发组(n=400)。记录患者既往病史并监测患者血清前白蛋白、同型半胱氨酸、白蛋白、尿酸、低密度脂蛋白、高密度脂蛋白等血液指标。结果①复发组高血压、糖尿病发生率显著高于初发组,前白蛋白、白蛋白、低密度脂蛋白、高密度脂蛋白水平均低于初发组,组间比较差异具有统计学意义(P<0.05);两组间性别、年龄、吸烟史、饮酒史及同型半胱氨酸、尿酸水平差异无统计学意义(P>0.05)。②Spearman相关性分析显示,前白蛋白与高血压、白蛋白、尿酸、低密度脂蛋白呈正相关(P<0.05),而与性别、年龄呈负相关(P<0.05)。③Logistic回归分析提示,高血压、糖尿病为非心源性脑梗死复发的独立危险因素,而前白蛋白、低密度脂蛋白、高密度脂蛋白是非心源性脑梗死复发的独立保护因素(P<0.05)。结论血清前白蛋白是非心源性复发性脑梗死的独立保护因素,提示二级预防中除重视高血压、糖尿病、血脂等常见危险因素外,还应重视血清前白蛋白对于非心源性复发脑梗死的重要作用。
Objective To investigate the relationship between serum prealbumin and noncardiogenic recurrent cerebral infarction,and provide evidence for secondary prevention.Methods A total of 1063 hospitalized patients with acute cerebral infarction at the neurology department in Jinan central hospital affiliated to Shandong university from August 2016 to June 2018 were divided into the primary group(n=663) and the recurrent group(n=400). The patient's medical history and serum prealbumin, homocysteine, albumin, uric acid, low density lipoprotein cholesterol,high density lipoprotein cholesterol and other blood indexes were recorded.Results ①The incidences of hypertension and diabetes in recurrent group were significantly higher than those in primary group, and the levels of prealbumin, albumin, low-density lipoprotein and high-density lipoprotein were significantly lower than those in primary group(all P<0.05).There were no significantly different in the sex, age,smoking and drinking history,the levels of homocysteine and uric acid between two groups(all P>0.05).②Spearman analysis showed that prealbumin was positively correlated with hypertension, albumin, uric acid and low-density lipoprotein(P<0.05),and negatively correlated with sex and age(P<0.05).③Logistic regression analysis showed that the hypertension and diabetes were independent risk factors for the recurrence of noncardiogenic cerebral infarction,while the prealbumin,low-density lipoprotein and high-density lipoprotein were independent protective factors(P<0.05).Conclusion Serum prealbumin is an independent protective factor of noncardiogenic recurrent cerebral infarction.It suggests that the important role of serum prealbumin in noncardiogenic recurrent cerebral infarction should be emphasized in the secondary prevention besides the common risk factors such as hypertension, diabetes and blood lipids.
引文
[1] 陈洪苹,钟镝,李国忠.单中心脑梗死住院患者病死率及死因分析[J].中国脑血管病杂志,2015,12(2):62-66
[2] 苏丹丹.急性脑梗死患者的住院经济负担分析[D].甘肃:兰州大学,2018
[3] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257
[4] 吴江,贾建平.神经病学[M].3版.北京:人民卫生出版社,2015:179
[5] 侯永革,王冬欣,张志涛,等.血浆同型半胱氨酸水平对脑梗死复发及中国缺血性卒中亚型分型的影响[J].临床误诊误治,2018,31(11):86-89
[6] 中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2014[J].中华神经科杂志,2015,48(4):258-273
[7] Larsen PD, Delallo LJ. Cerebrospinal fluid transthyretin in multiple sclerosis[J]. Neurology,1987,37(7):1262-1263
[8] Mohan A, Arora S, Uniyal A.Evaluation of plasma leptin, tumor necrosis factor-α, and prealbumin as prognostic biomarkers during clinical recovery from acute exacerbations of chronic obstructive pulmonary disease[J]. Lung India, 2017, 34 (1):3-8
[9] Louren?o P,Silva S,Fri?es F,et al. Low prealbumin is strongly associated with adverse outcome in heart failure[J].Heart, 2014,100(22):1780-1785
[10] Wang L, Xu H, Ren W,et al. Low serum prealbumin levels in post-stroke depression[J]. Psychiatry Res,2016,246:149-153
[11] Chen D, Bao L, Lu SQ, et al. Serum albumin and prealbumin predict the poor outcome of traumatic brain injury[J]. PLoS One,2014, 9(3): e93167
[12] 孔令恩,周谦武,蔡春生,等.血清前白蛋白与青年型脑梗死的关系[J].广东医学,2015,36(11):1728-1729
[13] Gao C, Zhang B, Zhang W,et al. Serum prealbumin (transthyretin) predict good outcomein young patients with cerebral infarction[J]. Clin Exp Med, 2011,11(1):49-54
[14] Zhang H,Shu Y,Zhang J,et al. Dynamics of nutritional status in dyingpatients with acute cerebral infarction incentral China: a preliminary study[J]. Neurol Res,2011, 33(5):503-507
[15] Santos SD, Lambertsen KL, Clausen BH, et al.CSF transthyretin neuroprotection in a mouse model of brain ischemia[J].J Neurochem,2010, 115(6): 1434-1444
[16] 宋康平,张玲玲,朱艳,等. 血清前白蛋白与脑出血预后的相关性研究[J]. 中风与神经疾病杂志,2016,33(10):920-922
[17] 刘文源,李爱英,孙晓晓,等. 血清前白蛋白和白蛋白与不同年龄段急性缺血性卒中患者短期转归的相关性[J].国际脑血管病杂志,2017,25(7):626-632
[18] 马元婧,邱润泽,袁冬平, 等.动脉粥样硬化中炎症免疫反应的研究进展[J].现代免疫学,2017,37(6):509-512
[19] 刘俊田.动脉粥样硬化发病的炎症机制的研究进展[J].西安交通大学学报(医学版),2015,36(2):141-152
[20] 胥雪莲,何川.炎症与动脉粥样硬化[J].心血管病学进展,2015,36(5):634-637
[21] 罗慧,陈建国,何东元.营养不良-炎症-动脉粥样硬化综合征研究进展[J].临床荟萃,2015,30(5):590-593
[22] 彭斌,孙佳,倪俊,等. 缺血性卒中患者血清前白蛋白水平与疾病严重程度关系的回顾性分析[J].中华临床营养杂志,2012,20(1):19-21
