血清Mg<sup>2+</sup>浓度与急性缺血性脑卒中患者短期结局的关系

冯佩; 牛晓虎; 梁辉; 胡健伟; 周蓦; 张永红; 佟伟军; 许锬

文章摘要

冯佩,牛晓虎,梁辉,胡健伟,周蓦,张永红,佟伟军,许锬.血清Mg²⁺浓度与急性缺血性脑卒中患者短期结局的关系[J].中华流行病学杂志,2012,33(11):1171-1175

血清Mg²⁺浓度与急性缺血性脑卒中患者短期结局的关系

Association between concentrations of serum magnesium and the short-term outcome of patients with acute ischemic stroke

收稿日期:2012-05-22 出版日期:2014-09-03

DOI：10.3760/cma.j.issn.0254-6450.2012.11.017

中文关键词: 缺血性脑卒中血清Mg²⁺ 预后

英文关键词: Acute ischemic stroke Serum magnesium Outcome

基金项目:

作者	单位	E-mail
冯佩	苏州大学医学部公共卫生学院流行病学教研室 215123
牛晓虎	苏州大学医学部公共卫生学院儿少卫生与社会医学教研室 215123
梁辉	苏州大学医学部公共卫生学院流行病学教研室 215123
胡健伟	昆山市妇幼保健所群体保健科
周蓦	苏州大学医学部公共卫生学院流行病学教研室 215123
张永红	苏州大学医学部公共卫生学院流行病学教研室 215123
佟伟军	苏州大学医学部公共卫生学院流行病学教研室 215123
许锬	苏州大学医学部公共卫生学院流行病学教研室 215123	xutan@suda,edu.Cn

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中文摘要:

目的探讨血清Mg²⁺浓度与急性缺血性脑卒中患者短期预后的关系，为改善其预后提供合理依据.方法以2006年1月1日至2008年12月30日在山东省4家医院住院急性缺血性脑卒中患者为调查对象，收集人口统计学、生活方式、疾病史、血生化指标、入院血压水平等资料.研究结局定义为出院的脑卒中量表评分(NIHSS)≥10分或者死亡.按NIHSS(NIH卒中评分)将研究对象分为两组，即死亡/NIHSS≥10及NIHSS＜10组.血清Mg²⁺浓度按四分位数分为4个水平.采用Cox比例风险模型分析血清Mg²⁺浓度与急性缺血性脑卒中患者短期预后的关系.结果死亡/NIHSS≥10组的血清Mg²⁺浓度、发病至入院时间低于NIHSS＜ 10组(P＜0.05)；入院时收缩压水平高于NIHSS＜ 10组(P＜0.05)；低密度脂蛋白胆固醇异常、空腹血糖受损及心房纤颤史的百分率均高于NIHSS＜ 10组(P＜0.05).单因素分析发现血清Mg²⁺浓度第4分位(最高水平)可以降低急性缺血性脑卒中患者发生死亡/NIHSS≥10的危险性(RR=0.47，P＜0.05)；调整血清Ca²⁺、K⁺水平等其他因素后，血清Mg²⁺第4分位和第3分位水平均可降低发生死亡/NIHSS≥10的危险性(RR值分别为0.39和0.54，P＜0.05).无论是否调整其他因素，血清Mg²⁺浓度与发生死亡/NIHSS≥10的危险性均存在着剂量反应关系(趋势检验P＜0.05).结论高浓度的血清Mg²⁺可降低急性缺血性脑卒中患者发生死亡/NIHSS≥10的危险性，并存在剂量反应关系.

英文摘要:

Objective To explore the relationship between the concentration of serum magnesium and the short-term outcome of patients with acute ischemic stroke, in order to provide evidence for improving the outcomes. Methods Patients with acute ischemic stroke under study, were from four hospitals in Shandong province. Data on demographic characteristics, life style related risk factors, history of cardiovascular disease, blood pressure at admission and other clinical characteristics were collected for all the participants. The outcomes were defined as National Institutes of Health Stroke Scale (NIHSS) ≥ 10 or death. According to NIHSS, the subjects were divided into two groups:death/NIHSS≥ 10 and NIHSS＜ 10. Concentrations of Mg²⁺ were categorized into four levels according to the quartiles of serum magnesium. Cox proportion hazard regression analysis was used to evaluate the association between serum magnesium concentrations and the short-term outcome of acute ischemic stroke. Results In the death/NIHSS≥10 group, concentrations of serum magnesium and the time from onset to admission were lower than that in the NIHSS＜ 10 group while the systolic blood pressure on admission, the proportion of low density lipoprotein abnormal, impaired fasting glucose and history of auricular fibrillation were all higher than that in the NIHSS＜ 10 group. Without the adjustment of multiple factors, when comparing to the lowest quartile of serum magnesium level, the fourth quartile (highest) seemed to have had a tendency of reducing the risk of death/NIHSS ≥ 10 (RR=0.47, P＜ 0.05). When multiple factors were adjusted (adjust serum calcium, potassium level and other factors), the fourth and the third quartiles could both reduce the risk of death/ NIHSS≥10 (RR values were 0.39 and 0.54, P＜0.05, respectively). With or without the adjustment of multiple factors, there appeared a dose-response relationship between serum magnesium concentrations and the risk to death/ NIHSS≥10 (trend P＜0.05). Conclusion Higher serum magnesium concentrations could reduce the risk to death/NIHSS ≥ 10, suggesting that there was a dose-response relationship between magnesium and the risk to death/NIHSS ≥ 10.

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