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一项观察性研究,探讨蛛网膜下腔出血患者微量白蛋白尿与 N 末端 pro-B 型利钠肽升高的关系。

An observational study of the association between microalbuminuria and increased N-terminal pro-B-type natriuretic peptide in patients with subarachnoid hemorrhage.

机构信息

Department of Anesthesia, Nagasaki Rosai Hospital, 2-12-5 Setogoe, Sasebo, 857-0134 Japan.

Department of Anesthesiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, 852-8501 Japan.

出版信息

J Intensive Care. 2015 Oct 14;3:42. doi: 10.1186/s40560-015-0108-1. eCollection 2015.

Abstract

BACKGROUND

The urinary albumin/creatinine ratio (ACR) is a significant neurologic prognostic predictor in patients with aneurysmal subarachnoid hemorrhage (SAH). B-type natriuretic peptide (BNP) plays an important role in body fluid regulation in patients with SAH. The present study was performed to determine whether ACR was independent predictor for unfavorable neurological outcome and ACR was associated with increased N-terminal pro-BNP (NT-pro-BNP) after SAH.

METHODS

We studied 61 patients undergoing surgery who were admitted within 48 h after aneurysmal SAH onset between July 2008 and June 2010. Hunt and Hess grade and Fisher grade were recorded at admission. The Glasgow Coma Scale (GCS) score was calculated at admission and daily for seven postoperative days. Arterial blood was sampled at admission and for seven postoperative days to determine the PaO2/FIO2 ratio, C-reactive protein level, troponin I level, and NT-pro-BNP level. Urine was sampled at admission and daily for seven postoperative days to determine ACR and vanillylmandelic acid/creatinine ratio (VMACR). Neurological outcomes were assessed at hospital discharge by using the Glasgow Outcome Scale. Receiver operating characteristic curves were constructed for the predictive variables of unfavorable neurological outcomes, and the area under the curve (AUC) was determined. Multivariate logistic regression analyses were performed for the significant predictors of unfavorable neurological outcomes after SAH. Associations with NT-pro-BNP were evaluated by using the Spearman rank correlation test.

RESULTS

Of the 61 patients, 24 had unfavorable outcomes. The prevalence rate of microalbuminuria was 85 % (52/61). The highest NT-pro-BNP levels were above the normal range in 57 of 61 patients (93 %). According to the AUC, the Hunt and Hess grade, GCS score, the highest ACR, and highest VMACR were significant predictors of neurological outcome. Multivariate logistic regression analyses showed that the highest ACR and Hunt and Hess grade are independent prognostic predictors of unfavorable neurological outcomes. The highest NT-pro-BNP significantly correlated with the highest troponin I, highest ACR, and VMACR on admission.

CONCLUSIONS

The highest ACR is an independent prognostic predictor of unfavorable neurological outcomes after SAH. Moreover, plasma NT-pro-BNP elevation may be associated with the development of microalbuminuria.

摘要

背景

尿白蛋白/肌酐比值(ACR)是蛛网膜下腔出血(SAH)患者重要的神经预后预测因子。B 型利钠肽(BNP)在 SAH 患者体液调节中发挥重要作用。本研究旨在确定 ACR 是否为不良神经预后的独立预测因子,以及 ACR 是否与 SAH 后 N 端脑利钠肽前体(NT-pro-BNP)升高有关。

方法

我们研究了 2008 年 7 月至 2010 年 6 月期间发病后 48 小时内接受手术的 61 例患者。入院时记录 Hunt 和 Hess 分级和 Fisher 分级。入院时和术后 7 天每天计算格拉斯哥昏迷量表(GCS)评分。入院时和术后 7 天每天抽取动脉血样,测定 PaO2/FIO2 比值、C 反应蛋白水平、肌钙蛋白 I 水平和 NT-pro-BNP 水平。入院时和术后 7 天每天采集尿液样本,测定 ACR 和香草扁桃酸/肌酐比值(VMACR)。出院时采用格拉斯哥预后量表评估神经功能结局。绘制预测不良神经结局的预测变量的受试者工作特征曲线,确定曲线下面积(AUC)。对 SAH 后不良神经结局的显著预测因子进行多变量 logistic 回归分析。采用 Spearman 秩相关检验评估与 NT-pro-BNP 的相关性。

结果

61 例患者中,24 例预后不良。微白蛋白尿患病率为 85%(52/61)。61 例患者中有 57 例(93%)的 NT-pro-BNP 水平高于正常范围。根据 AUC,Hunt 和 Hess 分级、GCS 评分、最高 ACR 和最高 VMACR 是神经功能结局的显著预测因子。多变量 logistic 回归分析显示,最高 ACR 和 Hunt 和 Hess 分级是不良神经结局的独立预后预测因子。入院时最高的 NT-pro-BNP 与最高肌钙蛋白 I、最高 ACR 和 VMACR 显著相关。

结论

最高 ACR 是 SAH 后不良神经结局的独立预后预测因子。此外,血浆 NT-pro-BNP 升高可能与微白蛋白尿的发生有关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4e86/4606477/55505ee2acf7/40560_2015_108_Fig1_HTML.jpg

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