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目的血清清蛋白作为一种神经保护剂其与急性缺血性脑卒中功能预后的关系尚无一致结论。文中旨在探讨营养状态良好的急性缺血性脑卒中患者血清清蛋白水平与短期功能预后的关系。方法收集2015年1月至2015年6月南京卒中登记系统中首次发病的急性缺血性脑卒中患者113例,收集人口学参数、人体测量参数、血管危险因素等相关临床及实验室检查等基线资料。采用美国国立卫生院卒中评估量表(National Institutes of Health Stroke Scale,NIHSS)对入院时的神经功能缺损严重程度进行评定,及出院时用改良Rankin评分(modified Rankin Scale,mRS)对短期功能预后进行评定,根据出院时mRS将患者分为预后良好组(mRS<3分)和预后不良组(mRS≥3分),最后采用多因素Logistic回归分析评估功能预后的独立预测因素。结果预后良好组52例(46.0%),预后不良组61例(54.0%)。与预后不良组患者比较,功能预后良好组患者BMI较高,而LDL-C、WBC较低,且入院时的NIHSS较低(P<0.05)。多因素Logistic回归分析显示:血清清蛋白较低、入院NIHSS、小动脉闭塞型是短期功能预后不良的独立预测因素;随着血清清蛋白水平的增加,患者功能预后不良的趋势降低(OR=0.684,95%CI:0.490~0.956);NIHSS增高患者功能预后不良的趋势增加(OR=3.490,95%CI:1.966~6.194);小动脉闭塞也是患者功能预后不良危险因素(OR=11.443,95%CI:1.160~112.857)。结论在营养状态良好的急性缺血性脑卒中患者中,血清清蛋白水平较低仍然是短期功能预后不良的独立预测因素。
Objective Serum albumin as a neuroprotective agent with acute ischemic stroke prognosis of functional no consensus. The purpose of this paper is to investigate the relationship between serum albumin level and short-term functional prognosis in patients with acute ischemic stroke who have good nutritional status. Methods A total of 113 acute ischemic stroke patients were recruited from Nanjing Stroke Registration System from January 2015 to June 2015. The baseline and other clinical and laboratory tests such as demographic parameters, anthropometric parameters and vascular risk factors were collected data. The severity of neurological deficits at admission was assessed using the National Institutes of Health Stroke Scale (NIHSS) and short-term functional outcome was assessed using modified Rankin Scale (mRS) at discharge from hospital According to the mRS at discharge, the patients were divided into good prognosis group (mRS <3 points) and poor prognosis group (mRS≥3 points). Finally, multivariate Logistic regression analysis was used to evaluate the independent predictors of functional outcome. Results The prognosis was good in 52 cases (46.0%), poor prognosis in 61 cases (54.0%). Patients with poor prognosis had higher BMI, lower LDL-C, lower WBC, and lower NIHSS at admission than those with poor prognosis (P <0.05). Multivariate logistic regression analysis showed that serum albumin was lower, admission NIHSS and arteriolar occlusion were independent predictors of short-term dysfunction prognosis. With the increase of serum albumin level, the prognosis of poor prognosis was decreased (OR = 0.684 (OR = 3.490, 95% CI: 1.966 ~ 6.194). The occlusion of arterioles was also a significant risk factor for patients with poor prognosis (OR = 11.443, 95% CI, CI: 1.160 ~ 112.857). Conclusions In patients with well-nourished acute ischemic stroke, lower serum albumin levels are still independent predictors of short-term functional outcome.