脑梗死患者慢性肾脏病与脑微出血发生的关系

Association of chronic kidney disease and cerebral microbleeds in patients with ischemic stroke

目的 探讨脑梗死患者慢性肾脏病与脑微出血发生的关系.方法 选择多中心连续入组发病1～6个月内的脑梗死患者636例,入组后2周内进行MRI检查,采用微出血解剖评定量表评分法评估脑微出血.参照美国全国肾脏基金会制定的肾脏病预后质量指南标准定义慢性肾脏病,以简化肾脏疾病饮食调整研究公式计算肾小球滤过率估计值（eGFR）.结果 636例脑梗死患者的平均年龄为（59.8±10.1）岁,其中男性435例（68.4％）.其中66例出现eGFR下降（＜60 ml·min-1·1.73 m-2）.201例（31.6％）有脑微出血,部位以深部和幕下最常见（133/201,66.2％）.eGFR下降患者脑微出血的发生率为48.5％ （32/66）,高于eGFR ≥60 ml·min-1·1.73 m-2的患者[29.6％（169/570,x2=9.709,P=0.002）].经单因素分析显示,年龄、高血压以及eGFR下降与脑微出血的发生有关.多因素分析显示eGFR下降与深部和幕下微出血的发生（OR=1.457,95％CI 1.044～2.034,P=0.027）独立相关,而与脑叶微出血的发生无明显相关.结论 脑梗死患者肾功能损害与深部和幕下脑微出血的发生有关.

Objective To investigate the association between the presence of cerebral microbleeds and chronic kidney disease in patients with ischemic stroke.Methods Patients with ischemic stroke within 1-6 months were consecutively recruited.Cranial MRI was taken within two weeks after recruitment.Cerebral microbleeds were assessed using Microbleed Anatomical Rating Scale on gradient echo MRI.Demographics including sex,age and risk factors were obtained.Chronic kidney disease was defined and classified according to National Kidney Fundation-Kidney Disease Outcome Quality Initiative Guideline.Glomerular filtration rate （GFR） was estimated by using the abbreviated Modification of Diet in Renal Disease equation.Results Of the 636 patients included,mean age was （59.8 ± 10.1） years,435 （68.4％） were male.Sixty-six had decreased estimated GFR （eGFR; ＜ 60 ml · min-1 · 1.73 m-2）.Two hundred and one （31.6％） patients had cerebral microbleeds,which were most commonly located in deep or infratentorial location （133/201,66.2％）.The presence of cerebral microbleeds was much higher in patients with decreased eGFR than the others （48.5％ （32/66） vs 29.6％ （169/570）,x2 =9.709,P =0.002）.Age,history of hypertension and decreased eGFR were associated with the presence of cerebral microbleeds in univariate analysis.In multivariate analysis,decreased eGFR was independently associated with the presence of cerebral microbleeds in deep or infratentorial location （OR =1.457,95％ CI 1.044-2.034,P =0.027）,but not associated with the presence of cerebral microbleeds in pure lobe.Conclusion Impaired kidney function is associated with the presence of cerebral microbleeds in deep or infratentorial regions in patients with ischemic stroke.