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浙江大学学报（医学版）
浙江大学学报（医学版）  2015, Vol. 44 Issue (1): 61-66    DOI: 10.3785/j.issn.1008-9292.2015.01.010
原著     
缺血性卒中患者急性期营养代谢相关指标的变化
洪庆1,2, 张力三1, 陈寅1, 何旭东1, 胡兴越1
1. 浙江大学医学院附属邵逸夫医院神经内科, 浙江 杭州 310016;
2. 温州医科大学附属温岭医院神经内科, 浙江 温岭 317500
Nutritional status in acute stage ischemic stroke and its relation to disease severity and prognosis of patients
HONG Qing1,2, ZHANG Li-san1, CHEN Yin1, HE Xu-dong1, HU Xing-yue1
1. Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China;
2. Department of Neurology, Wenling Hospital, Wenzhou Medical College, Wenling 317500, China
全文: PDF(1120 KB)  
摘要: 

目的:研究缺血性卒中患者急性期营养代谢的变化及与卒中严重程度的相关性.方法:纳入发病48 h内住院的缺血性卒中患者50例.用美国国立卫生研究院卒中量表(NIHSS)评估入院时卒中严重程度.入院第1天、第7天和第14天分别检查患者营养相关物理指标包括体质量、体质量指数、三头肌皮褶厚度、上臂围和上臂肌围及实验室指标包括血清前白蛋白、超敏C反应蛋白、补体C3和皮质醇水平.营养代谢紊乱严重程度用入院第7天与入院第1天营养代谢生化指标测定值的差值表示.所有患者在病程6个月时进行回访,以改良的Rankin评分量表评估卒中患者预后情况.结果:入院后患者的物理指标包括体质量、三头肌皮褶厚度、上臂围和上臂肌围无明显变化.入院第7天患者血清前白蛋白(198.8 mg/L±20.3 mg/L)和补体C3(0.6 g/L±0.1 g/L)较入院第1天(分别为286.7 mg/L±23.8 mg/L和1.0 g/L±0.1 g/L)明显下降(P <0.05),超敏C反应蛋白(24.1 mg/L±5.2 mg/L)和皮质醇(495.2 nmol/L±39.5 nmol/L)较入院第1天(分别为5.1 mg/L±1.2 mg/L和396.4 mol/L±41.3 mol/L)明显上升(P <0.05).入院第14天超敏C反应蛋白(13.2 mg/L±4.5 mg/L)和皮质醇(463.4 nmol/L±32.1 nmol/L)仍明显高于入院第1天(P <0.05),但较入院第7天有所下降,前白蛋白(259.2 mg/L±22.8 mg/L)和补体C3(0.8 g/L±0.2 g/L)与入院第1天比较差异无统计学意义(P >0.05).NIHSS分值及改良Rankin评分值均与营养代谢紊乱程度有关(P <0.05).结论:缺血性卒中急性期患者存在明显营养代谢紊乱,其严重程度与入院时卒中严重程度及预后均相关.
关键词 ： 卒中,  脑缺血,  C反应蛋白质,  补体C3,  前白蛋白,  氢化可的松    
Abstract：

Objective: To investigate the nutritional status in acute stage ischemic stroke and its relation to disease severity and prognosis of patients. Methods: Fifty patients with ischemic stroke were admitted in hospital within 48 h after onset. National Institute of Health stroke scale (NIHSS) was used to assess the severity of stroke. Physical index and laboratory index were measured on d1, d7 and d14 after admission. Physical index included body weight, body mass index, triceps skin folds, upper arm circumference and arm muscle circumference. Laboratory index included prealbumin, high sensitivity C-reactive protein (hs-CRP), complement C3 and cortisol. The severity of metabolic disturbance was expressed as the difference of biochemical indexes between the d7 and d1. All cases were followed up for 6 months. The prognosis of stroke was evaluated with modified Rankin (mRankin) scores. Results: No significant changes of physical indexes were found between d7 and d1. The levels of prealbumin and complement C3 on d7 after admission were significantly decreased compared to d1 (198.8 mg/L±20.3 mg/L vs 286.7 mg/L±23.8 mg/L and 0.6 g/L±0.1 g/L vs 1.0 g/L±0.1 g/L, respectively, both P <0.05). The levels of hs-CRP and cortisol at d7 were significantly increased compared to d1 (495.2 nmol/L±39.5 nmol/L vs 24.1 mg/L±5.2 mg/L and 396.4 nmol/L±41.3 nmol/L vs 5.1 mg/L±1.2 mg/L, respectively, both P <0.05). On d14 after admission hs-CRP(13.2 mg/L±4.5 mg/L) and cortisol levels (463.4 nmol/L±32.1 nmol/L) were still significantly higher than d1 (both P <0.05). However, there were no difference in prealbumin (259.2 mg/L±22.8 mg/L) and complement C3 (0.8 g/L±0.2 g/L) levels between d1 and d14 after admission. Correlation analysis revealed that the NIHSS scores and mRankin scores were correlated with nutrition metabolism disturbances (P <0.05). Conclusion: Nutrition metabolism disturbances in patients with acute ischemic stroke are related to the disease duration, the severity and prognosis of stroke.
Key words： Stroke    Brain ischemia    C-Reactive protein    Complement C3    Prealbumin    Hydrocortisone
收稿日期: 2014-04-10
CLC:  R743.3  
基金资助:

国家自然科学基金(81371258).
通讯作者: 胡兴越(1962-),男,主任医师,从事脑血管病的临床和研究工作;E-mail: huxingyue2003@126.com     E-mail: huxingyue2003@126.com
作者简介: 洪 庆(1981-),女,硕士研究生,主治医师,从事脑血管病的临床和研究工作;E-mail: hq2166@126.com
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引用本文:

洪庆, 张力三, 陈寅, 何旭东, 胡兴越. 缺血性卒中患者急性期营养代谢相关指标的变化[J]. 浙江大学学报（医学版）, 2015, 44(1): 61-66.
HONG Qing, ZHANG Li-san, CHEN Yin, HE Xu-dong, HU Xing-yue. Nutritional status in acute stage ischemic stroke and its relation to disease severity and prognosis of patients. Journal of ZheJiang University(Medical Science), 2015, 44(1): 61-66.

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http://www.zjujournals.com/xueshu/med/CN/10.3785/j.issn.1008-9292.2015.01.010      或      http://www.zjujournals.com/xueshu/med/CN/Y2015/V44/I1/61

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