江阴市脑梗死住院患者慢性肾脏病发病情况调查

The Prevalence of Chronic Kidney Disease in Inpatients with Cerebral Infarction in Jiangyin

目的:调查江阴市脑梗死住院患者的慢性肾脏病(CKD)发病情况及危险因素。方法:收集江阴市人民医院神经内科2007年1月～2009年12月间住院的脑梗死患者的临床资料。所有患者均经脑CT和(或)磁共振成像(MRI)确诊。观察肾脏损伤指标(Scr、尿常规)及相关危险因素(血压、烟酒史、心脏病史、脑卒中部位、血糖血脂等)。采用简化MDRD公式估算GFR,并根据K/DOQI指南进行CKD分期。结果:共收集脑梗死住院患者4287例,资料完整者3809例,其中男2298例,女1511例,平均年龄(68.70±11.21)岁。蛋白尿269例(8.72%),血尿524例(16.99%),Scr大于105μmol/L者344例(9.03%),eGFR≤60ml·min-1·1.73m-2者389例(10.21%)。CKD为926例,患病率为24.31%;CKD1～5期分别占该人群的30.35%、27.65%、38.44%、3.02%与0.54%;本组病例中,年龄≥65岁者CKD患病率为32.01%,eGFR≤60ml·min-1·1.73m-2的比例为10.90%。logistic回归分析脑梗死患者CKD危险因素为年龄(OR=1.414,P<0.01)、性别(OR=1.634,P<0.01)、糖尿病(OR=1.409,P<0.01)、房颤(OR=1.999,P<0.01)、高尿酸(OR=3.566,P<0.01)、高低密度脂蛋白(OR=1.541,P<0.05)、高血磷(OR=1.421,P<0.01)、低Hct(OR=1.629,P<0.01),颞叶(OR=1.518,P<0.01)梗死更易合并CKD。结论:江阴地区脑梗死住院患者中CKD患病率24.31%,明显高于一般人群,应重视在脑卒中病人中的CKD调查,早期预防和积极干预CKD,以改善患者预后。

Objective：To investigate the prevalence and risks of chronic kidney diseases （CKD） in inpatients with cerebral infarction in Jiangyin district. Methods：4287 inpatients with cerebral infarction from neurology department of Jiangyin hospital from Jan. 2007 to Dec. 2009 were recruited,among which 3809 hospitalized patients had complete record data. M/F ratio was 2298/1511 and mean age was（68.70 ± 11.21 ）years. All the patients were respectively diagnosed by brain CT and/or MRI. Laboratory data in- cluded routine urinalysis, fasting plasma glucose, Scr, uric acid, etc. Glomerular filtration rate （GFR） was estimated by simplified MDRD equation and CKD stage was classified according to K/DOQI guidelines. Results： The prevalence of albuminuria and hematuria was 269 cases （8.72%） and 524 cases （ 16.99% ）, respectively. Scr 〉 105 μmol/L amounted to 344 cases （9.03%）, eGFR 〈 60 ml ·main-1 · 1.73 m-2 1 389 cases（ 10.21% ）. The prevalence of CKD was 926 cases（24.31% ）. The percentage of these inpatients in CKD stage 1 to 5 was approximately 30. 35% （281/926） ,27.65% （256/926） ,38.44% （356/926） ,3.02% （28/926） and O. 54% （5/926） ,respectively. Logistic regression model showed that age（ OR = 1. 414 ,P 〈 0.01 ）, gender（ OR = 1. 634, P 〈 0.01 ）, diabetes mellitus （ OR = 1. 409, P 〈 0.01 ）, fibrillation atrial （ OR = 1. 999, P 〈 0.01 ）, hyperuricaemia （ OR = 3. 566, P 〈 0.01 ）, high low - den- sity lipoprotein cholesterol （ OR = 1. 541, P 〈 O. 05）, hyperphosphoremia （ OR = 1.421, P 〈 0.01 ） ,lower hematocrit （ OR = 1. 629, P 〈0.01 ）were independently associated with CKD. CKD occurred more likely in patients with temporal lobe（ OR = 1. 518 ,P 〈0.01 ） infarction. Conclusion：The prevalence of CKD in inpatients with cerebral infarction was 24.31% in Jiangyin, which is significantly higher than that of general population. More attention should be paid to the evaluation of CKD among patients with cerebral infarction. Early detection and active prevention could improve the prognosis of patients with CKD.