肾小球滤过率对急性脑梗死后自发性出血转化的影响

Influence of glomerular filtration rate on hemorrhagic transformation in patients with acute ischemic stroke

目的探讨肾小球滤过率（GFR）对急性脑梗死后自发性出血转化的影响。方法连续观察首都医科大学附属北京安贞医院神经内科2012年9月至2014年1月确诊的急性脑梗死患者581例，收集患者的一般资料和临床信息，依据影像学表现将研究对象分为出血转化组（54例）和无出血转化组（527例），收集患者血清肌酐和尿素氮化验数值并按照慢性肾脏病流行病合作工作组（CKDEPI）方程计算出估计肾小球滤过率（eGFR），分析eGFR与急性脑梗死患者自发性出血转化之间的关系。结果单因素分析显示：自发出血转化组患者既往心房颤动［38.9%（21/54）比 14.2%（75/527），P〈0.01］、大面积脑梗死［38.9%（21/54）比6.8%（36/527），P〈0.01］以及GFR下降，与非出血转化组相比，2组间差异均有统计学意义。调整性别、年龄、大面积脑梗死、既往心房颤动病史后，经多因素Logistic回归分析后显示：GFR减低（GFR＜60 ml/（min·1.73 m2）是急性脑梗死自发出血转化的独立危险因素；与肾脏功能正常患者相比，GFR〈30 ml/（min·1.73 m2）的急性脑梗死患者发生自发性出血转化的风险增加了2.17倍［比值比（OR）=3.17，95%置信区间（CI）：1.37~8.28］；同时显示大面积脑梗死（OR=8.68，95%CI：4.56~16.51）、心房颤动（OR=3.84，95%CI：2.11~6.98）也是脑梗死出血转化的独立危险因素。若大面积急性脑梗死患者同时伴有肾功能下降［GFR〈30 ml/（min·1.73 m2）］，与肾功能正常患者相比，自发性出血转化风险增加了15.04倍 （OR=16.04，95%CI：11.21~253.68）。结论GFR下降的急性脑梗死患者应高度警惕自发性出血性转化的可能，即GFR下降可以预测患者自发性出血性转的风险。

ObjectiveTo investigate the relation between the glomerular filtration rate（GFR） and the risk of hemorrhagic transformation in acute ischemic stroke patients. MethodsWe consecutively enrolled 581 acute ischemic stroke patients. The baseline demographic clinical and laboratory information were collected. All the patients were assigned to hemorrhagic transformation[（HT） group,n=54] or nonHT（n=527） by the imaging findings. The estimate GFR was calculated with the use of the Chroinc Kidney DiseaseEpidemiology Collaboration （CKDEPI） equaution. The impact of the GFR on the hemorrhagic transformation was investigated. Results The univariate analysis showed the HTs were more frequent in patients with atrial fibrillation, diabetes, largesize infarction and decreased GFR（P〈0.05）. The multiple logistic regression analysis showed there was a significant association between the[GFR〈30 ml/（min·1.73 m2）]group and HTs in acute ischemic stroke（OR=3.17,95%CI：1.37 to 8.28）. Compared with normal renal function patients , the incidence of HTs was higher in the [GFR〈30 ml/（min·1.73 m2）]group（OR=16.04,95%CI：11.21 to 253.68）.ConclusionLow levels of GFR are associated with a high risk of HT after acute ischemic stroke and the decrease of GFR may be a prognosis of the HT after acute ischemic stroke.