脑梗死患者微量白蛋白尿与脑卒中危险因素及复发的相关性

背景国外研究发现脑卒中危险因素与微量白蛋白尿有一定的关系,但结果并不一致.目的研究急性脑梗死患者微量白蛋白尿的发生率、与脑卒中危险因素及脑梗死复发的关系.设计以急性脑梗死患者和有脑梗死危险因素者为研究对象,以健康老年人为对照组的病例-对照研究.单位一所大学医院的神经内科病房.对象选择2000-01/2001-12重庆医科大学附属第一医院神经内科脑梗死及有脑梗死危险因素的住院病例共214例,年龄50～80岁.急性脑梗死组(发病在1周之内)78例,脑梗死危险因素组,如高血压、糖尿病、冠心病、短暂性脑缺血发作或脑卒中史(6个月以上)患者56例,28例健康老年人作为对照组.其中联合组包括急性脑梗死患者78例和脑梗死危险因素组中有短暂性脑缺血发作或脑卒中史者31例,共109例.方法测定过夜空腹12 h以上血白蛋白、血肌酐、血糖、总胆固醇、总三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇;用放射免疫法测定早晨第1次尿中白蛋白.主要观察指标①终点结局指标随访2年新血管事件(包括脑卒中复发、心肌梗死和血管性死亡)的发生率;②危险性指标脑梗死危险因素与微量白蛋白尿的关系;③替代指标各组微量白蛋白尿的发生率.结果急性脑梗死患者中微量白蛋白尿者占35%,显著高于脑梗死危险因素组(15%)和对照组(3.5%)(P均＜0.01).急性脑梗死组和联合组中存在6个独立预测微量白蛋白尿的危险因素,分别是糖尿病、血白蛋白水平、年龄、冠心病、高血压及高密度脂蛋白胆固醇(P＜0.05或P＜0.01).随访(1.5±0.9)年,急性脑梗死组23%再发血管意外,显著高于脑梗死危险因素组(12%)和对照组(0%)(P均＜0.01).急性脑梗死组微量白蛋白尿者36%再发血管意外,与大量白蛋白尿者(41%)和正常白蛋白尿者(10%)相比,差异均有显著性意义(P＜0.05).在急性脑梗死组、脑梗死危险因素组控制糖尿病、高血压后,微量白蛋白尿是脑卒中复发独立的预测指标,危险率分别是3.8(95%CI,1.2～13.5;P＜0.05)、4.7(95%CI,1.4～16.7;P＜0.01).结论急性脑梗死患者微量白蛋白尿较常见.在调整脑卒中基本危险因素后,微量白蛋白尿是脑梗死复发的独立危险因素.

Association of microalbuminuria with the risk factors of stroke and recurrence in patients with cerebral infarction

BACKGROUND: International research discovers that the risk factors of stroke have certain correlation with microalbuminuria(MAU) but the results are inconsistent.OBJECTIVE: To investigate the relationship between the incidence of MAU in patients with acute cerebral infarction and the risk factor of stroke and the recurrence of cerebral infarction.DESIGN: A case-control study based on patients with acute cerebral infarction and individuals with risk factors of cerebral infarction, and the healthy elderly as controls.SETTING: Inpatient department of neurology in a university hospital.PARTICIPANTS: Totally 214 cases with cerebral infarction or risk factors of cerebral infarction aged between 50 and 80 years old were selected from the Department of Neurology of the First Affiliated Hospital of Chongqing Medical University between January 2000 and December 2001. Acute cerebral infarction group (infarction group, attack within one week, n =78), cerebral infarction risk factor group(risk group, n = 56), such as, hypertension, diabetes,coronary heart disease (CHD), transient ischemic attack(TIA) or stroke history(more than 6 months), and healthy elderly(control group, n=28) .Thereinto, combined group( n = 109) included 78 cases of acute cerebral infarction and 31 cases with TIA or stroke history of risk factors.METHODS: Seralbumin, serum creatine(SCr), blood sugar, total cholesterol, total triacylglycerol(TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol(LDL-C) were detected after more than 12 hours of fasting. The albumin in the first urine in the morning was detected by radio-immunity analysis.the incidence of neo-vascular affair in 2 years of follow-up including recurtute indicator: incidence of MAU in each group.RESULTS: Patients with MAU accounted for 35% of acute cerebral infarction, which were significantly higher than that of risk group(15% ) and control group(3.5%, P ＜ 0.01). Six independent risk factors predicting MAU existed in infarction group and combined group, which were diabetes, seralbumin level, age, CHD, hypertension, and HDL-C( P ＜ 0. 05, or P ＜ 0.01).After(1.5 ±0. 9) years of follow-up, 23% of patients of infarction group suffered from recurrent vascular accident, which was significantly higher than that of risk group(12% ) and control group(0%, P ＜ 0.01 ). 36% of MAU patients in infarction group suffered from recurrent vascular accident, which was significantly different from that of patients with a great deal of albuminuria(41% ) and normal albuminuria(10%, P ＜ 0. 05). MAU is the independent predicting indicator for the recurrence of stroke after the control of diabetes and hypertension in patients of infarction group and risk group with the risk rate of 3.8 (95% CI, 1.2-13.5; P ＜0.05) or 4. 7(95%CI,1.4-16.7, P ＜ 0.01).CONCLUSION: MAU is quite common in acute cerebral infarction patients. After the adjustment of basic risk factors, MAU is the independent risk factor of the recurrence of cerebral infarction.