血尿素氮/白蛋白比值与大动脉粥样硬化性卒中严重程度和短期转归的相关性

Blood Urea Nitrogen to Albumin Ratio Is Associated with Large Atherosclerosis Stroke, Its Severity and Short-Term Outcome

摘要: 目的：探讨血尿素氮/白蛋白比值(Blood urea nitrogen to albumin ratio, BAR)与大动脉粥样硬化性卒中(large artery atherosclerosis, LAA)严重程度和短期转归的相关性。方法：回顾性纳入2017年9月至2022年8月在青岛大学附属医院住院的LAA型卒中患者。根据入院时美国国立卫生研究院卒中量表评分进一步分为轻度卒中组(≤8分)和中重度卒中组(>8分)，根据出院时改良Rankin量表评分进一步分为转归良好组(≤2分)和转归不良组(>2分)。采用多变量logistic回归分析确定BAR与LAA严重程度和短期转归的相关性。通过受试者工作特征(receiver operating characteristic, ROC)曲线评估BAR对LAA患者转归不良的预测价值。结果：研究共纳入2014例患者，其中，男性1331例(66.1%)，女性683例(33.9%)，年龄(64.72 ± 11.72)岁。其中轻度卒中1047例(52.0%)，中重度卒中967例(48.0%)，出院时转归良好1030例(51.1%)，转归不良984例(48.9%)。在LAA患者中，中重度卒中组和短期转归不良组BAR分别显著高于轻度卒中组与短期转归良好组。多变量logistic回归分析显示，BAR是LAA严重程度(OR 1.374, 95% CI 1.308~1.442; P < 0.001)和短期转归不良(OR 1.374, 95% CI 1.308~1.442; P < 0.001)的独立危险因素，ROC曲线分析显示，BAR预测LAA患者短期转归不良的曲线下面积为0.744 (95% CI 0.722~0.765; P< 0.001)，约登指数为0.366，最佳截断值为7.150，敏感性和特异性分别为81.7%和54.9%。结论：BAR与LAA型卒中患者的严重程度和短期转归不良有关，并且对LAA型卒中患者短期转归具有良好的预测价值。

Abstract: Objective: To investigate the relationship between Blood urea nitrogen to albumin ratio (BAR) and large artery atherosclerosis (large artery atherosclerosis, LAA) and its correlation with severity and short-term outcomes. Methods: LAA stroke patients hospitalized in the Affiliated Hospital of Qingdao University from September 2017 to August 2022 were retrospectively included. According to the score of National Institutes of Health Stroke Scale at admission, they were further divided into mild stroke group (≤8 points) and moderate to severe stroke group (>8 points), and according to the score of modified Rankin scale at discharge, they were further divided into good outcome group (≤2 points) and poor outcome group (>2 points). Multivariate logistic regression analysis was used to determine the correlation between BAR and LAA severity and short-term outcome. The predictive value of BAR for adverse outcomes in LAA patients was evaluated by receiver operating characteristic (ROC) curve. Results: A total of 2014 patients were included in the study, including 1331 males (66.1%) and 683 females (33.9%), aged (64.72 ± 11.72) years. Among them, there were 1047 cases (52.0%) of mild stroke, 967 cases (48.0%) of moderate and severe stroke, 1030 cases (51.1%) of good outcome at discharge, and 984 cases (48.9%) of poor outcome. In LAA patients, BAR in moderate to severe stroke group and short-term adverse outcome group was significantly higher than that in mild stroke group and short-term good outcome group, respectively. Multivariate logistic regression analysis showed that BAR was the severity of LAA (OR 1.374, 95% CI 1.308~1.442; P < 0.001) and poor short-term outcomes (OR 1.374, 95% CI 1.308~1.442; Independent risk factors (P < 0.001), ROC curve analysis showed that the area under the curve for BAR to predict adverse short-term outcomes in LAA patients was 0.744 (95% CI 0.722~0.765; P < 0.001), the Jorden index was 0.366, the best cutoff value was 7.150, the sensitivity and specificity were 81.7% and 54.9%, respectively. Conclusion: BAR is associated with the severity and short term outcome in LAA patients, and has a good predictive value for short term outcome in patients with LAA.