急性腔隙性脑梗死患者慢性肾功能不全与脑微出血的相关性研究

Correlation study of cerebral microbleeds with chronic renal failure in patients with acute lacunar stroke

目的慢性肾疾病(CKD)可增加患者出血性卒中发病风险,而脑微出血(CMBs)正是一种具有出血倾向的小血管病。文中对急性腔隙性脑梗死患者CKD与CMBs的发生及部位进行探讨。方法回顾性连续纳入2014年1月至2016年7月期间在芜湖市第一人民医院神经内科住院治疗的急性(发病7 d内)腔隙性脑梗死患者308例。所有患者行常规磁共振序和梯度回波T2加权扫描,记录患者人口学、实验室检查、临床相关资料[血管学危险因素和美国国立卫生研究院卒中量表(NHISS)评分等]及影像学资料。采用CKD流行病学合作研究公式估算患者的肾小球滤过率(e GFR)。CKD定义为e GFR<60 m L/(min·1.73 m2)。结果入组患者平均年龄(65.79±8.67)岁,NHISS评分为3(2~5)分。其中女性130例(42.2%),CKD患者62例(20.1%),CMBs阳性患者116例(37.7%)。将患者按照e GFR水平分成CKD组和正常组。单因素分析结果显示,糖尿病(P=0.014)和CMBs(P=0.001)在组间分布差异有统计学意义。按照部位进行细化,CMBs在CKD组和正常组患者间的分布差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,单纯深部CMBs[OR=7.61,95%CI:4.18~16.55,P=0.001]是CKD发生的独立危险因素,而单纯脑叶混合部位CMBs对CKD的发生无明显作用。结论单纯深部CMBs是急性腔隙性梗死患者发生的独立危险因素;而单纯脑叶和混合部位CMBs与梗死的发生无明显相关性。

Objective Cerebral small vessel disease is closely related to kidney disease. Chronic kidney disease （CKD） may increase the risk of hemorrhage stroke. However, its impact on hemorrhage-prone small vessel disease represented by cerebral microb- leeds（CMBs） remains unclear. The purpose of this study was to investigate the relationship of CKD with the presence and location of CMBs in patients with acute lacunar stroke. Method Consecutive patients with acute lacunar stroke within 7 days from onset were enrolled retrospectively from January 2014 to July 2016 and scanned by gradientecho T2 ＊ -weighted imaging （ GRE-T2 ＊ WI）. Their demographic, clinical, laboratory and imaging data were collected. Estimate glomerular filtration rate （eGFR） was calculated individu-ally by the following chronic kidney disease epidemiology collaboration （ CKD-EPI） equation for the Asian population. CKD was defined as the level of eGFR〈60 miymin/1.73 m^2. Results Finally, 308 patients （ mean age： 65.79±8.67 years; median NHISS： 3 （ 2 - 5） ; 42.2% Female） with lacunar ischemic stroke were enrolled in the final analysis. Among these patients, CMBs were present in 116 patients （37.7%） and CKD in 62 patients （20.1%）. Patients were divided into CKD group and normal group according to GFR level. The result of univariate analysis showed that patients with CKD had higher prevalence of diabetes （P = 0.014） and higher degrees of CMBs （ P = 0.001） compared with normal group. CMBs were refined by its location. The result of multivariable analysis showed that CMBs in deep brain [OR = 7.61, 95% Cl 4 .18-16.55, P = 0.001] were significantly associated with CKD incidence, while no significant relationship was found in CKD incidence and CMBs in the lobe and mixed location of brain. Conclusion The CKD incidence in patients with acute lacunar stroke is in dependent relationship with CMBs in deep brain and without significant correlation with CMBs in the lobe and mixed location of brain.