肾小球滤过率和扩大的血管周围间隙在缺血性卒中患者预后评价中的价值

The value of glomerular filtration rate and enlarged perivascular space in the prognosis evaluation of patients with acute ischemic stroke

目的探讨缺血性卒中患者肾小球滤过率与扩大的血管周围间隙在预后评价中的价值。方法共171例急性缺血性卒中患者按照改良Rankin量表(m RS)评分分为预后不良组(88例)和预后良好组(83例),检测血清肌酐水平并计算肾小球滤过率,计数基底节区和半卵圆中心扩大的血管周围间隙数量并评分,测量基底节区和半卵圆中心扩大的血管周围间隙直径并分级。结果与对照组相比,预后不良组和预后良好组扩大的血管周围间隙评分(P=0.002,0.000)和血清肌酐水平(P=0.000,0.000)均升高、肾小球滤过率降低(P=0.001,0.000),预后不良组扩大的血管周围间隙评分(P=0.001)和血清肌酐水平(P=0.034)高于预后良好组、肾小球滤过率低于预后良好组(P=0.000)。扩大的血管周围间隙分级0级17例、1级89例、2级43例、3级22例,3级组和2级组血清肌酐水平高于1级组和0级组(均P=0.000)、肾小球滤过率低于1级组和0级组(均P=0.000)。相关分析显示,预后不良组和预后良好组患者m RS评分与扩大的血管周围间隙评分呈正相关(r=0.350,P=0.033;r=0.481,P=0.036),与肾小球滤过率呈负相关(r=-0.447,P=0.018;r=-0.553,P=0.002)。结论缺血性卒中患者m RS评分与扩大的血管周围间隙评分呈正相关、与肾小球滤过率呈负相关,二者均可作为缺血性卒中患者预后的预测指标。

Objective To explore the value of glomerular filtration rate （GFR） and enlarged perivascular space （EPVS） in the prognosis evaluation of patients with acute ischemic stroke. Methods A total of 171 cases of acute ischemic stroke were divided into poor prognosis group （N = 88） and good prognosis group （N = 83） according to modified Rankin Scale （mRS） score. Another 50 healthy people were selected as control group. Serum creatinine （Cr） level and GFR were detected, and EPVS in basal ganglia and centrum semiovale was calculated and graded. Results Compared with control group, the EPVS scores （P = 0.002, 0.000） and serum Cr levels （P = 0.000, 0.000） in poor prognosis group and good prognosis group were significantly increased, while GFR （P = 0.001, 0.000） in both groups was significantly decreased. The EPVS score （P = 0.001） and serum Cr level （P = 0.034） in poor prognosis group were significantly higher than those in good prognosis group, while GFR （P = 0.000） was significantly lower. According to EPVS diameter, 171 patients were divided into 4 grades （Grade 0-3）： 17 cases in Grade O, 89 cases in Grade 1, 43 cases in Grade 2 and 22 cases in Grade 3. Serum Cr levels in patients with Grade 3 and Grade 2 were significantly higher than those with Grade 1 and Grade 0 （P = 0.000, for all）, while GFR were significantly lower than those with Grade 1 and Grade 0 （P = 0.000, for all）. Correlation analysis showed that mRS score was positively correlated with EPVS score （r = 0.350, P = 0.033; r = 0.481, P = 0.036） and negatively correlated with GFR （r =- 0.447, P = 0.018; r =- 0.553, P = 0.002） in poor prognosis group and good prognosis group. Conclusions The mRS score of acute ischemic stroke patients is positively correlated with EPVS score and negatively correlated with GFR. Both of them can be used as index to predict the prognosis of acute ischemic stroke.