前白蛋白、白蛋白对不同年龄段脑梗死短期预后的预测价值

发布时间：2018-07-20 17:53

【摘要】：目的分析急性脑梗死的危险因素,探讨不同年龄段脑梗死患者血清前白蛋白及白蛋白对其短期预后的预测价值。方法病例组:纳入2014年6月至2016年6月发病48小时内入院的新发急性脑梗死患者622例,根据年龄分为小于45岁、45-59岁、60-74岁、75-89岁4组,在发病第14天行改良的Rankin量表(mRS)评分,mRS评分≤2分为预后良好,m RS评分≥3分则为预后不良。根据各年龄段预后不同,各年龄段内又分为预后良组和预后不良组。对照组:纳入同期对应年龄及性别查体患者446例,并分为小于45岁、45-59岁、60-74岁、75-89岁4组。比较病例组与对照组、预后良与预后不良组研究对象的人口统计学资料(性别、年龄、体重指数)、血管危险因素(高血压、糖尿病、缺血性心脏病、房颤、吸烟、饮酒史)、血压(收缩压、舒张压)、生化指标(前白蛋白、白蛋白、总白蛋白、总胆红素、直接胆红素、间接胆红素、甘油三脂、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、尿素氮、肌酐、尿酸、磷)差异是否有统计学意义。采用logistics回归分析以上因素哪些是脑梗死的危险因素及哪些是保护性因素。分析各年龄段血清前白蛋白及白蛋白对其短期预后的预测价值。结果1、病例组与对照组相比,年龄、体重指数、高血压、糖尿病、冠心病、房颤、吸烟及饮酒史比例及收缩压和舒张压高低,以及前白蛋白、白蛋白、总白蛋白、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、总胆红素、间接胆红素、肌酐、尿酸水平差别均具有统计学意义(P0.05),进行多变量logistic回归分析,年龄、体重指数、吸烟、房颤、血压(收缩压、舒张压)、总胆固醇、直接胆红素、肌酐为脑梗死的独立危险因素,而前白蛋白、白蛋白、总蛋白、高密度脂蛋白胆固醇、总胆红素、尿酸为独立保护性因素。2、对于病例组,预后良与预后不良组相比,两组研究对象年龄、体重指数及性别差异、糖尿病、房颤病人的比例,以及前白蛋白、白蛋白、甘油三脂、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、总胆红素、直接胆红素、间接胆红素、尿素氮、肌酐、尿酸差别均具有统计学意义(P0.05),多变量logistic回归分析示,性别、糖尿病、低密度脂蛋白胆固醇、总胆红素、尿素氮为脑梗死预后不良的独立危险因素,而体重指数、前白蛋白、白蛋白、甘油三酯、肌酐为独立保护性因素。3、对病例组与对照组、预后良与预后不良组进行多变量logistic回归分析,在校正其他脑梗死的危险因素后,前白蛋白及白蛋白为脑梗死及其短期预后的独立保护性因素(病例对照组:前白蛋白OR=0.981,P0.001,白蛋白OR=0.819,P0.001;预后良与预后不良组:前白蛋白OR=0.997,P0.034,白蛋白OR=0.941,P0.020)。4、对于病例组预后良与预后不良组的预测分析中,仅小于45岁组前白蛋白对脑梗死的短期预后有预测价值(ROC曲线下面积为0.768,95%CI为0.617-0.919,P=0.022),其他各组均无明显的预测价值。结论前白蛋白及白蛋白是急性脑梗死及其短期预后的独立保护性因素,不同年龄段急性脑梗死前白蛋白及白蛋白对其短期预后的价值不同,前白蛋白对小于45岁的脑梗死患者的短期预后有预测价值。
[Abstract]:Objective to analyze the risk factors of acute cerebral infarction and to explore the predictive value of serum prealbumin and albumin on the short-term prognosis of cerebral infarction in different age groups. Method case group: 622 cases of newly onset acute cerebral infarction hospitalized within 48 hours from June 2014 to June 2016 were divided into 45 years old, 45-59 years old, 60-74 years old, 7 The improved Rankin scale (mRS) score of the 5-89 year old group was scored on fourteenth days, the mRS score was less than 2 and the prognosis was good, and the m RS score was worse than 3. According to the different age groups, the prognosis group was divided into good prognosis group and poor prognosis group. The control group was included in 446 cases of age and sex examination in the same period, and divided into less than 45. Age, 45-59 years, 60-74 years, 75-89 years old and 4 groups. Compare the demographic data (sex, age, body mass index), blood vessel risk factors (hypertension, diabetes, ischemic heart disease, atrial fibrillation, smoking, drinking history), blood pressure (systolic pressure, diastolic pressure), biochemical index (prealbumin, white egg). White, total bilirubin, total bilirubin, direct bilirubin, indirect bilirubin, glycerin three fat, total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, urea nitrogen, creatinine, uric acid, phosphorus, were statistically significant. Logistics regression analysis of the above factors are the risk factors of cerebral infarction and which are protective causes Analysis of the prognostic value of serum prealbumin and albumin in all ages. Results 1. Age, body mass index, hypertension, diabetes, coronary heart disease, atrial fibrillation, smoking and drinking history, systolic pressure and diastolic pressure, and prealbumin, albumin, total albumin, total albumin, total cholesterol, glycerol three, compared with the control group. Esters, high density lipoprotein cholesterol, total bilirubin, indirect bilirubin, creatinine, and uric acid levels were all statistically significant (P0.05). Multivariable logistic regression analysis, age, body mass index, smoking, atrial fibrillation, blood pressure (systolic pressure, diastolic pressure), total cholesterol, direct bilirubin, creatinine as independent risk factors for cerebral infarction, and pre white eggs White, albumin, total protein, high density lipoprotein cholesterol, total bilirubin, uric acid as an independent protective factor.2. Compared with the group with good prognosis and poor prognosis, the two groups of subjects were age, body mass index and sex difference, the proportion of diabetes, atrial fibrillation, and prealbumin, albumin, glycerol three fat, high density lipoprotein gallbladder Alcohol, low density lipoprotein cholesterol, total bilirubin, direct bilirubin, indirect bilirubin, urea nitrogen, creatinine and uric acid were all statistically significant (P0.05). Multivariate logistic regression analysis showed that sex, diabetes, low density lipoprotein cholesterol, total cholesterol, urea nitrogen were independent risk factors for poor prognosis of cerebral infarction, and body mass index Prealbumin, albumin, triglyceride, creatinine were independent protective factors of.3. A multivariate logistic regression analysis was performed in a case group and a control group with good prognosis and poor prognosis. After correcting the risk factors of other cerebral infarction, prealbumin and albumin were independent protective factors for cerebral infarction and its short-term prognosis. Albumin OR=0.981, P0.001, albumin OR=0.819, P0.001; prognosis good and poor prognosis group: prealbumin OR=0.997, P0.034, albumin OR=0.941, P0.020).4. In the prediction analysis of benign and poor prognosis group of case group prognosis, only 45 years old group prealbumin is of predictive value for the short-term prognosis of cerebral infarction (ROC curve area is 0.768,95%CI. 0.617-0.919, P=0.022), other groups have no significant predictive value. Conclusion prealbumin and albumin are independent protective factors for acute cerebral infarction and its short-term prognosis. The value of prealbumin and albumin for the short-term prognosis of acute cerebral infarction in different ages is different, prealbumin is prealbumin for short term prealbumin for patients less than 45 years of age. Then there is a predictive value.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.33

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