急性腔隙性脑梗死患者肾功能减退与脑微出血进展的相关性研究

Relationship between impaired renal function and cerebral microbleeds progression in patients with acute lacunar infarcts

目的探讨急性腔隙性脑梗死患者肾功能减退与进展性脑微出血（CMBs）的相关性。方法连续收集自2013年6月至2015年6月于解放军第九十二医院脑科中心住院的首次急性腔隙性脑梗死患者546例。所有患者于入院后24h内完成血清肌酐水平测定，参考慢性肾脏病流行病合作工作组（CKD—EPI）方程计算肾小球滤过率估计值（eGFR）。入院2d内及随访1年时行头颅MRI包含梯度回波序列）检查，采用脑微出血解剖评定量表（MARS）评定CMBs。进展性CMBs定义为在基线MRI基础上,随访MRJ时出现任何新发CMBs。结果最终有344例患者完成随访并纳入统计分析，其中进展性CMBs组62（16．4％1例。进展性CMBs组eGFR显著低于无进展性CMBs组[63．9（56．1，90．1）mL／（min·1．73m^2）vs.76．9（60．4，98．5）mL／（min·1．73m^2）]，差异有统计学意义（P〈0．05）。经多变量Logistic回归分析显示，eGFR水平下降是进展性CMBs（OR=1．560，95％CI1．031～2．391，P=-0．009）的独立危险因素。结论急性腔隙性脑梗死患者肾功能减退与进展性CMBs有显著相关关系。

Objective To examine the association between impaired renal function and cerebral microbleeds （CMBs） progression in patients with acute lacunar infarcts. Methods Five hundred and forty-six consecutive patients with first-episode acute lacunar infarcts were prospectively recruited between June 2013 and June 2015. Serum creatinine was measured within 24 h of admission. Estimated glomerular filtration rate （eGFR） was calculated by Chronic Kidney Disease Epidemiology Collaboration （CKD-EPI） equation. Baseline and follow-up brain magnetic resonance imaging （including gradient-echo images） was obtained within two days of admission and one year after stroke onset, respectively. CMBs were rated with Microbleed Anatomical Rating Scale （MARS）. Progression of CMBs was defined as the presence of any new microbleed on follow-up magnetic resonance imaging. Results Three hundred and forty-four patients who completed follow-up were included in final statistical analysis. CMBs progression was present in 62 patients （16.4%）. The eGFR in patients with CMBs progression was significantly lower than that in patients without CMBs progression （63.9[56.1-90.1] mL/[min·1.73 m^2] vs. 76.9[60.4-98.5] mL/[min· 1.73 m^2], P〈0.05）. Logistic regression analysis indicated that decreased eGFR was independently associated with CMBs progression （OR=1.560, 95%CI： 1.031-2.391, P=-0.009） one year after adjusting for confounding factors. Conclusion Impaired renal function is found to be significantly associated with CMBs progression in lacunar stroke patients.