尿白蛋白肌酐比增高预测急性缺血性卒中短期预后的临床研究

目的 观察急性缺血性卒中（acute ischemic stroke，AIS）患者的临床特点及入院时的尿白蛋白肌酐比（albumin-to-creatinine ratio，ACR）和估算的肾小球滤过率（evaluated glomerular filtration rate，eGFR）对患者3个月预后的影响。方法 本研究为前瞻性研究，连续性纳入北京医院2017年3月27日-11月16日住院治疗的AIS患者作为研究对象。收集患者一般资料、血管危险因素、ACR、eGFR和其他相关实验室检查结果，评估患者入院时NIHSS评分，随访3个月时的mRS评分。按照患者是否有肾功能障碍分为肾功能障碍组和肾功能正常组，比较两组的临床特点；按照患者3个月的mRS评分，分为预后良好组（mRS评分0～2分）和预后不良组（mRS评分3～6分），比较两组的上述临床特点，并分析3个月预后不良的独立危险因素。结果 共纳入115例患者，AIS患者的肾功能障碍患病率为44.3%（51/115）。与肾功能正常组相比，肾功能障碍组平均年龄较高（P =0.009）；糖尿病（P =0.001）、冠状动脉粥样硬化性心脏病（P =0.026）、心房颤动（P =0.003）的发病率较高；入院时NIHSS评分（P =0.013）、入院后的血糖（P =0.001）、血浆纤维蛋白原（P =0.008）及D -二聚体（P =0.001）水平较高。与预后良好组相比，预后不良组的平均年龄较高（P =0.007）；既往卒中史（P =0.002）、心房颤动患病率（P =0.040）、血浆纤维蛋白原（P =0.004）及D-二聚体水平（P <0.001）较高；入院时NIHSS评分（P <0.001）较高。高血压、糖尿病、血脂代谢异常、冠状动脉粥样硬化性心脏病、吸烟史在预后良好组及预后不良组的差异无统计学意义。与预后良好组相比，预后不良组ACR更高（P <0.001），而eGFR（P =0.030）更低。多因素分析显示入院时NIHSS评分≥8分（OR 27.05，95%CI 3.75～178.18，P=0.001）、ACR≥3 mg/mmo（l OR 35.50，95%CI 4.79～262.94，P＜0.001）、卒中史（OR 20.48，95%CI 2.35～178.18，P =0.006）是3个月预后不良的独立危险因素。结论 AIS患者的肾功能障碍患病率较高，入院时ACR增高的AIS患者3个月预后较差。

The Prediction Value of High Urinary Albumin Creatinine Ratio for Short-term Functional Outcome in Acute Ischemic Stroke

Objective To investigate the clinical characteristics of acute ischemic stroke (AIS) patients, and the
effect of urinary albumin-to-creatinine ratio (ACR), the evaluated glomerular filtration rate (eGFR)
at admission on the functional outcome at 90 days in AIS patients.
Methods This was a prospective study which enrolled consecutive AIS patients who were
hospitalized in Department of Neurology, Beijing Hospital from March 27, 2017 to November 16,
2017. Data of general information, vascular risk factors, ACR, eGFR, and related laboratory tests,
NIHSS score on admission were collected. The outcome was evaluated by a mRS score at 3 months.
Based on renal function state, all patients were divided into renal dysfunction group and normal
renal function group, and the clinical characteristics between the two groups were compared. Based
on the mRS at 3 months, all patients were divided into good prognosis group (mRS: 0-2) and poorprognosis group (mRS: 3-6), the clinical characteristics between the two groups were compared and
independent risk factors for poor prognosis at 3 months were analyzed.
Results A total of 115 patients were included in this study. The prevalence of renal dysfunction in
AIS patients was 44.3% (51/115). Compared with normal renal function group, renal dysfunction
group had a higher mean age (P =0.009), and higher incidence of diabetes (P =0.001), coronary
heart disease (P =0.026) and atrial fibrillation (P =0.003), and a higher NIHSS score (P =0.013) on
admission, and higher levels of blood glucose (P =0.001), plasma fibrinogen (P =0.008) and D-dimer
(P =0.001) on admission. Compared with good prognosis group, poor prognosis group had a higher
mean age (P =0.007), a higher rate of history of stroke (P =0.002), a higher incidence of atrial
fibrillation (P =0.040), higher levels of plasma fibrinogen (P =0.004) and D-dimer (P <0.001), higher
NIHSS (P <0.001) score on admission. There were no statistical difference in hypertension, diabetes,
abnormal lipid metabolism, coronary atherosclerotic heart disease, and smoking history between
the good prognosis and poor prognosis groups. Compared with the good prognosis group, the poor
prognosis group had higher ACR (P <0.001) and lower eGFR (P =0.030). Multivariate analysis
showed that the NIHSS score≥8 on admission (OR 27.05, 95%CI 3.75-178.18, P =0.001), ACR≥3
mg/mmol (OR 35.50, 95%CI 4.79-262.94, P <0.001), history of stroke (OR 20.48, 95%CI 2.35-
178.18, P =0.006) were independent risk factors for poor prognosis at 3 months.
Conclusions AIS patients had a higher prevalence of renal dysfunction. The AIS patients with high
ACR at admission had a poorer outcome at 3 months.