尿白蛋白/肌酐比值对急性脑梗死患者神经功能恶化的预测价值
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摘要
目的评估尿白蛋白/肌酐比值(UACR)对急性脑梗死患者神经功能恶化的预测能力。方法研究对象为98例急性脑梗死患者。入院时对患者的血液和尿液进行常规检测,包括eGFR和UACR。结果 98例患者中有67例(68.4%)被诊断为肾功能不全,20例(20.4%)患者出现神经功能恶化。患者入院时年龄、血糖水平、UACR和NIHSS评分均与神经功能恶化有关,而患者入院时eGFR与神经功能恶化无相关性。多元逻辑回归分析显示,神经功能恶化与入院UACR和NIHSS评分呈正相关。结论研究表明,入院时高UACR可预测急性脑梗死患者神经功能恶化。
Objective To investigate the ability of urinary albumin/creatinine ratio(UACR) to predict neurological deterioration in patients with acute cerebral infarction. Methods We retrospectively enrolled 98 patients that were admitted to our hospital with acute cerebral infarction. General blood and urine examinations, including eGFR and UACR measurements, were performed on admission.Neurological deterioration was defined as a ≥4-point increase in the National Institutes of Health Stroke Scale(NIHSS) score within 7 days after admission. Results Kidney dysfunction was diagnosed in 67 of the 98 patients(68.4%). Neurological deterioration was ob-served in 20 patients(20.4%). Age, blood glucose level on admission, UACR on admission, and NIHSS score on admission were significantly associated with neurological deterioration, while no relationship between eGFR on admission and neurological deterioration was identified. A multivariable logistic regression analysis showed that neurological deterioration was positively associated with UACR and NIHSS score. Conclusions Our data suggest that high UACR on admission may predict neurological deterioration in patients with acute cerebral infarction.
Objective To investigate the ability of urinary albumin/creatinine ratio(UACR) to predict neurological deterioration in patients with acute cerebral infarction. Methods We retrospectively enrolled 98 patients that were admitted to our hospital with acute cerebral infarction. General blood and urine examinations, including eGFR and UACR measurements, were performed on admission.Neurological deterioration was defined as a ≥4-point increase in the National Institutes of Health Stroke Scale(NIHSS) score within 7 days after admission. Results Kidney dysfunction was diagnosed in 67 of the 98 patients(68.4%). Neurological deterioration was ob-served in 20 patients(20.4%). Age, blood glucose level on admission, UACR on admission, and NIHSS score on admission were significantly associated with neurological deterioration, while no relationship between eGFR on admission and neurological deterioration was identified. A multivariable logistic regression analysis showed that neurological deterioration was positively associated with UACR and NIHSS score. Conclusions Our data suggest that high UACR on admission may predict neurological deterioration in patients with acute cerebral infarction.
引文
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[7]Toyoda K. The cerebro-renal interaction in stroke neurology[J]. Neurology, 2012, 78(24):1898-1899.
[8]Satchell S. The role of the glomerular endothelium in albumin handling[J]. Nat Rev Nephrol, 2013, 9(12):717-725.
[9]Cho B H, Kim J T, Chang J, et al. Prediction of hemorrhagic transformation in acute ischaemic stroke by micro-and macroalbuminuria after intravenous thrombolysis[J]. Eur J Neurol, 2013, 20(8):1145-1152.
[2]Yahalom G, Schwartz R, Schwammenthal Y, et al. Chronic kidney disease and clinical outcome in patients with acute stroke[J].Stroke, 2009, 40(4):1296-1303.
[3]Saji N, Sato T, Sakuta K, et al. Chronic Kidney Disease Is an Independent Predictor of Adverse Clinical Outcomes in Patients with Recent Small Subcortical Infarcts[J]. Cerebrovascular Diseases Extra, 2014, 4(2):174-181.
[4]Matsuo S, Imai E, Horio M, et al. Revised Equations for Estimated GFR From Serum Creatinine in Japan[J]. Am J Kidney Dis,2009, 53(6):982-992.
[5]Suda S, Katsumata T, Okubo S, et al. Low serum n-3 polyunsaturated fatty acid/n-6 polyunsaturated fatty acid ratio predicts neurological deterioration in Japanese patients with acute ischemic stroke[J]. Cerebrovasc Dis, 2013, 36(5-6):388.
[6]S?owik A, Turaj W, Iskra T, et al. Microalbuminuria in Nondiabetic Patients with Acute Ischemic Stroke:Prevalence, Clinical Correlates, and Prognostic Significance[J]. Cerebrovasc Dis, 2002, 14(1):15-21.
[7]Toyoda K. The cerebro-renal interaction in stroke neurology[J]. Neurology, 2012, 78(24):1898-1899.
[8]Satchell S. The role of the glomerular endothelium in albumin handling[J]. Nat Rev Nephrol, 2013, 9(12):717-725.
[9]Cho B H, Kim J T, Chang J, et al. Prediction of hemorrhagic transformation in acute ischaemic stroke by micro-and macroalbuminuria after intravenous thrombolysis[J]. Eur J Neurol, 2013, 20(8):1145-1152.