急性脑梗死患者微量白蛋白尿与卒中相关 危险因素的关系探讨

目的 探讨微量白蛋白尿（microalbuminuria，MAU）与急性脑梗死危险因素及其病情严重程度的关系。
方法 采用前瞻性研究方法，连续收集2011年7月～2013年7月在上海市第一人民医院分院神经内科
住院且发病时间72 h内的急性脑梗死患者166例为研究对象，其中男89例，女77例，应用免疫比浊法
测定患者的尿微量白蛋白水平，根据检测结果将所有患者分成MAU阳性组（81例）和MAU阴性组（85
例）。比较两组间一般临床资料及生化指标是否存在差异，并采用Logistic回归分析评估MAU与脑梗死
危险因素的相关性。
结果 166例患者中，有81例（48.8%）存在MAU。MAU阳性组与阴性组比较，糖尿病（χ2=8.116，
P =0.004）、收缩压（t =2.735，P =0.007）、美国国立卫生研究院卒中量表（National Institutes of Health
Stroke Scale，NIHSS）（t =2.612，P =0.01）、血糖（t =2.68，P =0.008）、低密度脂蛋白胆固醇（t =2.217，
P =0.028）和C反应蛋白（t =5.548，P =0.000）差异有显著性。Logistic回归分析显示，糖尿病［优势比
（odds ratio，OR）为1.51，95%可信区间（confidence interval，CI）1.26～2.47，P =0.01］、收缩压（OR 1.47，
95%CI 1.01～1.17，P =0.004）、低密度脂蛋白胆固醇（OR 2.43，95%CI 1.01～5.37，P =0.03）和C反应蛋
白（OR 1.79，95%CI 1.09～1.21，P =0.005）均为MAU的独立危险因素。
结论 MAU与高血压、糖尿病、C反应蛋白、血脂等脑梗死危险因素密切相关。

Analysis on the Relationship between Microalbuminuria and the Risk Factors of Acute Ischemic Stroke

Objective To investigate the relationship between microalbuminuria（MAU） and the risk factors of acute ischemic stroke.Methods A prospective observation study was adopted in this study. One hundred and sixty-six consecutive patients with acute ischemic stroke were included and divided into two groups： MAU positive group（n=81） which was defined as MAU level 20～300 mg/L, and negative group（n=85） which was defined as MAU level 20 mg/L. The clinical data and laboratory results in two groups were compared.Results Diabetes（χ2=8.116, P=0.004）, systolic pressure（t =2.735, P=0.007）, National Institutes of Health Stroke Scale（NIHSS）（t =2.612, P =0.01）, fasting blood glucose（t =2.68, P =0.008）, low density lipoprotein cholesterol（t =2.217, P =0.028） and C-reactive protein（t =5.548, P =0.000） in MAU positive group were significantly higher than those in MAU negative group. Logistic regression analysis shows diabetes（odds ratio, OR] 1.51, 95%confidence interval, CI] 1.26～2.47, P =0.01）, systolic pressure（OR 1.47, 95%CI 1.01～1.17, P =0.004）, low density lipoprotein cholesterol（OR 2.43, 95%CI 1.01～5.37, P=0.03） and C-reactive protein（OR 1.79, 95%CI 1.09～1.21, P=0.005） were dependent risk factors of MAU.Conclusion MAU increasing was related to the risk factors of ischemic stroke, including hypertension, diabetes, C-reactive protein and low density lipoprotein cholesterol. MAU increasing might indicate the severity of illness in patients with acute ischemic stroke.