急性脑梗死伴非瓣膜性心房颤动患者肾功能不全的影响因素分析

Analysis of influencing factors of renal insufficiency in acute cerebral infarction patients with non-valvular atrial fibrillation

目的观察急性脑梗死伴非瓣膜性心房颤动患者肾功能不全的发生率及其影响因素。方法回顾性连续纳入2013年1月至2015年1月首都医科大学宣武医院神经内科住院的急性脑梗死伴非瓣膜性心房颤动患者266例,以估算肾小球滤过率（e GFR）评价肾功能,e GFR〈60 ml/（min·1.73 m2）为肾功能不全,并分为肾功能不全组（36例）和无肾功能不全组（230例）。观察伴非瓣膜性心房颤动的急性脑梗死患者肾功能不全发生率及其影响因素。结果 （1）266例伴非瓣膜性心房颤动的急性脑梗死患者,肾功能不全发生率为13.5%（36例）。肾功能不全组年龄≥65岁患者比例高于无肾功能不全组,差异有统计学意义[94.4%（34/36）比70.0%（161/230）,P=0.002],余一般资料差异均无统计学意义（均P〉0.05）。（2）多因素Logistic回归分析显示,年龄（≥65岁）是伴非瓣膜性心房颤动的急性脑梗死患者发生肾功能不全的独立危险因素（OR=1.147,95%CI：1.087-1.209,P〈0.01）,而高血压（OR=0.870,95%CI：0.362-2.089,P=0.755）、糖尿病（OR=1.078,95%CI：0.403-2.883,P=0.882）、高脂血症（OR=1.666,95%CI：0.645-4.302,P=0.292）病史与该类患者发生肾功能不全不相关。结论伴有非瓣膜性心房颤动的急性脑梗死患者肾功能不全发生率偏高,年龄（≥65岁）为该类患者发生肾功能不全的独立危险因素。

Objective To observe the incidence and the influencing factors of kidney insufficiency in acute cerebral infarction patients with non-valvular atrial fibrillation. Methods From January 2013 to January 2015,266 consecutive acute cerebral infarction patients with non-valvular atrial fibrillation admitted to the Department of Neurology,Xuanwu Hospital, Capital Medical University were enrolled retrospectively. Renal function was assessed by the estimated glomerular filtration rate （eGFR）,eGFR 〈60ml/（min · 1.73 m2 ） was defined as renal insufficiency,and were divided into a renal insufficiency group （n = 36） and a non-renal insufficiency group （n = 230）. The incidence of kidney insufficiency and its influencing factors in acute cerebral infarction patients with non-valvular atrial fibrillation were observed. Results （1） In 266 acute cerebral infarction patients with non-valvular atrial fibrillation, the prevalence of renal insufficiency was 13.5% （n =36）. The proportion of age （ ≥65 years） of the renal insufficiency group was higher than that of the non-renal insufficiency group. There was significant difference （ 94.4% [ 34/36 ] vs. 70.0% [ 161/230 ] ;P = 0.002 ）. There were no significantly differences in general information of others （ all P 〉 0. 05 ）. （2） Multiple Logistic regression analysis showed that the age （ ≥65 years） was an independent risk factor for the occurrence of renal insufficiency in acute cerebral infarction patients with atrial fibriUation （ OR, 1. 147,95% CI 1. 087 - 1. 209 ; P 〈 0.01 ）, and the histories of hypertension （ OR, 0. 870,95% CI0. 362-2. 089 ;P = 0.755 ）, diabetes mellitus （ OR, 1.078,95 % CI 0. 403 - 2.883 ; P = 0.882 ）, and hyperlipidemia （ OR,1. 666,95% CI0. 645 -4. 302;P = 0. 292） were not associated with renal insufficiency in cerebral infarction patients with atrial fibrillation. Conclusions The incidence of renal insufficiency in cerebral infarction patients with atrial fibrillation is higher. Age （ ≥65 years） is an independent risk factor for renal insufficiency in this type of patients.