细胞外水分比率对急性缺血性卒中患者出院结局的影响

doi:10.3969/j.issn.1673-5765.2025.04.009

摘要/Abstract

摘要： 目的探讨细胞外水分比率（ratio of extracellular water to total body water，ETR）对急性缺血性卒中（acute ischemic stroke，AIS）患者出院结局的影响。
方法回顾性分析2018年7月—2024年6月在北京市房山区良乡医院神经内科住院的AIS患者，根据出院结局将患者分为结局良好（mRS评分＜3分）组和结局不良（mRS评分≥3分）组。比较两组患者的临床资料和ETR等指标的差异，采用多因素logistic回归分析探讨ETR对患者出院结局的影响，并在不同性别、年龄、BMI、骨骼肌质量指数及入院NIHSS评分亚组中分析ETR对出院结局的影响。
结果共纳入AIS患者147例，平均年龄（68.9±12.2）岁，其中男性80例（54.4%），结局良好组107例（72.8%），结局不良组40例（27.2%）。多因素logistic回归分析显示，ETR升高（OR 2.09，95%CI 1.16～3.76，P=0.014）和ETR≥40.0%（OR 6.24，95%CI 1.33～29.32，P=0.020）是AIS患者出院结局不良的危险因素。亚组分析结果稳健，无明显交互作用（P交互＞0.05）。在年龄＜71岁、BMI≥24 kg/m2以及入院NIHSS评分≥3分亚组中，ETR对出院结局不良的影响具有显著性。
结论 ETR是AIS患者出院结局的独立影响因素，高ETR可显著增加出院结局不良的风险。

文章导读： 本研究的多因素分析结果显示，ETR升高是AIS患者出院结局不良的独立影响因素，ETR每升高1%，出院结局不良的风险升高1.09倍；ETR≥40.0%较ETR＜40.0%，出院结局不良风险升高6.24倍。

关键词: 急性缺血性卒中; 生物电阻抗分析; 细胞外水分比率; 出院结局

Abstract: Objective To investigate the effects of the ratio of extracellular water to total body water (ETR) on discharge outcomes in patients with acute ischemic stroke (AIS).
Methods Patients with AIS who were hospitalized in the Neurology Department, Liangxiang Hospital of Beijing Fangshan District, from July 2018 to June 2024 were retrospectively analyzed. They were divided into two groups based on their discharge outcomes: the good outcome (mRS score＜3 points) group and the poor outcome (mRS score≥3 points) group. Differences in clinical data and indicators like ETR were compared between the two groups. Multivariate logistic regression analysis was used to explore the effect of ETR on patient discharge outcomes. Furthermore, subgroup analyses were conducted to evaluate ETR’s effect on discharge outcomes by sex, age, BMI, skeletal muscle index, and admission NIHSS score.
Results A total of 147 AIS patients were included, with an average age of (68.9±12.2) years, including 80 males (54.4%), 107 cases (72.8%) in the good outcome group, and 40 cases (27.2%) in the poor outcome group. Multivariate logistic regression analysis showed that increased ETR (OR 2.09, 95%CI 1.16-3.76, P=0.014) and ETR≥40.0% (OR 6.24, 95%CI 1.33-29.32, P=0.020) were risk factors for poor discharge outcomes in patients with AIS. The subgroup analysis results remained robust with no significant interaction (Pinteraction＞0.05). In the subgroup of patients with age<71 years, BMI≥24 kg/m2, and admission NIHSS score≥3 points, the effect of ETR on poor discharge outcomes was significant.
Conclusions ETR is an independent factor influencing discharge outcomes in patients with AIS, and high ETR can significantly increase the risk of poor discharge outcomes.

Key words: Acute ischemic stroke; Bioelectrical impedance analysis; Ratio of extracellular water to total body water; Discharge outcome

中图分类号:

R74
R151

王岩, 郝怀宇, 陆强, 张蕾, 沈学延, 魏桂梅. 细胞外水分比率对急性缺血性卒中患者出院结局的影响[J]. 中国卒中杂志, 2025, 20(4): 457-461.

WANG Yan, HAO Huaiyu, LU Qiang, ZHANG Lei, SHEN Xueyan, WEI Guimei. Effects of the Ratio of Extracellular Water to Total Body Water on Discharge Outcomes in Patients with Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2025, 20(4): 457-461.

参考文献

[1] 中国卒中学会，中国卒中学会神经介入分会，中华预防医学会卒中预防与控制专业委员会介入学组. 急性缺血性卒中血管内治疗中国指南2023[J]. 中国卒中杂志，2023，18（6）：684-711.
Chinese Stroke Association，Chinese Interventional Neuroradiology Society，Intervention Group of Committee of Stroke Prevention and Control of Chinese Preventive Medicine Association. Chinese guideline for endovascular treatment of acute ichemic stroke 2023[J]. Chin J Stroke，2023，18（6）：684-711.
[2] 程实，李静，郭军平，等. 卒中后感染对急性缺血性卒中患者出院结局的影响[J]. 中国卒中杂志，2023，18（8）：885-890.
CHENG S，LI J，GUO J P，et al. Effects of post-stroke infection on discharge outcomes in patients with acute ischemic stroke[J]. Chin J Stroke，2023，18（8）：885-890.
[3] PÉREZ-MORALES R，DONATE-CORREA J，MARTÍN-NÚÑEZ E，et al. Extracellular water/total body water ratio as predictor of mortality in hemodialysis patients[J]. Ren Fail，2021，43（1）：821-829.
[4] YANG J X，KONG L，ZHANG W D，et al. ECW/TBW is increased in type 1 diabetes mellitus patients with diabetic peripheral neuropathy：a retrospective case-control study[J/OL]. Int J Diabetes Dev Ctries，2023，43：419-424[2024-11-10]. https://doi.org/10.1007/s13410-022-01104-0.
[5] BERNEIS K，KELLER U. Bioelectrical impedance analysis during acute changes of extracellular osmolality in man[J]. Clin Nutr，2000，19（5）：361-366.
[6] 毛雅，姚颖. 生物电阻抗分析的临床应用[J]. 华中科技大学学报（医学版），2022，51（5）：706-711.
MAO Y，YAO Y. The clinical application of bioelectrical impedance analysis[J]. Acta Med Univ Sci Technol Huazhong，2022，51（5）：706-711.
[7] IRISAWA H，MIZUSHIMA T. Correlation of body composition and nutritional status with functional recovery in stroke rehabilitation patients[J/OL]. Nutrients，2020，12（7）：1923[2024-11-10]. https://doi.org/10.3390/nu12071923.
[8] SIOTTO M，GERMANOTTA M，GUERRINI A，et al. Relationship between nutritional status，food consumption and sarcopenia in post-stroke rehabilitation：preliminary data[J/OL]. Nutrients，2022，14（22）：4825[2024-11-10]. https://doi.org/10.3390/nu14224825.
[9] 谢翼，徐俊马，胥方琴，等. 肌少症指数对老年急性缺血性脑卒中患者预后的预测价值研究[J]. 中国全科医学，2024，27（11）：1326-1330，1336.
XIE Y，XU J M，XU F Q，et al. Predictive value of sarcopenia index for prognosis in elderly patients with acute ischemic stroke[J]. Chinese General Practice，2024，27（11）：1326-1330，1336.
[10] AKIMOTO T，TASAKI K，ISHIHARA M，et al. Association of body water balance，nutritional risk，and sarcopenia with outcome in patients with acute ischemic stroke：a single-center prospective study[J/OL]. Nutrients，2024，16（13）：2165[2024-11-10]. https://doi.org/10.3390/nu16132165.
[11] WILCZYŃSKI J，MIERZWA-MOLENDA M，HABIK-TATAROWSKA N. Differences in body composition among patientsafter hemorrhagic and ischemic stroke[J/OL]. Int J Environ Res Public Health，2020，17（11）：4170[2024-11-10]. https://doi.org/10.3390/ijerph17114170.
[12] CHEN L K，WOO J，ASSANTACHAI P，et al. Asian Working Group for Sarcopenia：2019 consensus update on sarcopenia diagnosis and treatment[J]. J Am Med Dir Assoc，2020，21（3）：300-307.
[13] CHUNG Y J，LEE G R，KIM H S，et al. Effect of rigorous fluid management using monitoring of ECW ratio by bioelectrical impedance analysis in critically ill postoperative patients：a prospective，single-blind，randomized controlled study[J]. Clin Nutr，2024，43（9）：2164-2176.
[14] 李佳楠，李立宏. 缺血性脑卒中后脑水肿的发病机制及治疗进展[J]. 临床医学进展，2024，14（4）：2769-2778.
LI J N，LI L H. The pathogenesis and treatment progress of cerebral edema after ischemic stroke[J]. Advances in Clinical Medicine，2024，14（4）：2769-2778.
[15] HUNT A，ESSA A，MACNAB R. Regulation of fluid and electrolyte balance[J]. Anaesthesia & Intensive Care Medicine，2024，25（5）：332-338.
[16] RITZ P，VOL S，BERRUT G，et al. Influence of gender and body composition on hydration and body water spaces[J]. Clin Nutr，2008，27（5）：740-746.