Komatsu Teppei, Okumura Motohiro, Kida Hiroyuki, Ozawa Masakazu, Mimori Masahiro, Kokubu Tatsushi, Takahashi Junichiro, Kurihara Sumire, Maku Takahiro, Motegi Haruhiko, Takahashi Maki, Shiraishi Tomotaka, Nakada Ryoji, Akiyama Shiho, Kitagawa Tomomichi, Sato Takeo, Takatsu Hiroki, Sakai Kenichiro, Umehara Tadashi, Omoto Shusaku, Murakami Hidetomo, Mitsumura Hidetaka, Iguchi Yasuyuki
Department of Neurology, The Jikei University School of Medicine.
J Atheroscler Thromb. 2024 Mar 1;31(3):306-315. doi: 10.5551/jat.64230. Epub 2023 Sep 14.
Urinary immunoglobulin G (IgG) may be a stronger marker of atherosclerosis than microalbuminuria are because urinary IgG reflects proteinuria level and size-selectivity loss. Microalbuminuria-not urinary IgG-is associated with mild acute ischemic stroke (MAIS).
Using the Jikei University School of Medicine Stroke Registry, we selected and screened patients with symptomatic acute ischemic stroke (onset-to-door time ≤ 24 h). The exclusion criteria were (1) on-admission NIHSS scores ＞10, (2) a modified Rankin Scale (mRS) score ≥ 2 prior to stroke onset, (3) incomplete data (no urinalysis ≤ 3 days after admission or no mRS score at 90 days from stroke onset), and (4) an active malignancy. Patients at 90 days post-discharge were divided into those with favorable mRS scores of 0-1 and those with unfavorable mRS scores of 2-6. Clinical backgrounds were compared for (1) patients with positive and negative urinary IgG results, and (2) patients with favorable and unfavorable outcomes.
Of our study's 210 patients (164=male, median age=68, median eGFR=53.2 ml/min/1.73 m), 30 (14%) presented with positive urinary IgG, which was associated with cardiovascular risk factors. Higher BNP, higher D-dimer, lower eGFR, and higher CAVI were associated with higher positive urinary IgG. The favorable group, comprising 155 (74%) patients, had higher negative urinary IgG than the unfavorable group (89% vs 76%, P=0.026). No statistical difference emerged regarding microalbuminuria (29% vs 29%, P=1.000).
In MAIS, urinary IgG was associated with both the presence of atherosclerosis and an unfavorable outcome at 90 days after stroke onset.
尿免疫球蛋白G（IgG）可能是比微量白蛋白尿更强的动脉粥样硬化标志物，因为尿IgG反映蛋白尿水平和大小选择性丧失。与轻度急性缺血性卒中（MAIS）相关的是微量白蛋白尿而非尿IgG。
利用东京慈惠会医科大学卒中登记处，我们选择并筛选了有症状的急性缺血性卒中患者（发病至入院时间≤24小时）。排除标准为：（1）入院时美国国立卫生研究院卒中量表（NIHSS）评分＞10；（2）卒中发作前改良Rankin量表（mRS）评分≥2；（3）数据不完整（入院后≤3天未进行尿液分析或卒中发作后90天无mRS评分）；（4）患有活动性恶性肿瘤。出院后90天的患者分为mRS评分良好（0 - 1分）和mRS评分不良（2 - 6分）两组。比较（1）尿IgG结果为阳性和阴性的患者以及（2）预后良好和不良的患者的临床背景。
在我们研究的210例患者（164例男性，中位年龄 = 68岁，中位估算肾小球滤过率[eGFR]=53.2 ml/min/1.73 m²）中，30例（14%）尿IgG呈阳性，这与心血管危险因素相关。脑钠肽（BNP）升高、D - 二聚体升高、eGFR降低和动脉僵硬度指数（CAVI）升高与尿IgG阳性率升高相关。预后良好组有155例（74%）患者，其尿IgG阴性率高于预后不良组（89%对76%，P = 0.026）。微量白蛋白尿方面无统计学差异（29%对29%，P = 1.000）。
在MAIS中，尿IgG与动脉粥样硬化的存在以及卒中发作后90天的不良预后均相关。
