老年慢性肾功能不全继发脑血管疾病头颅MR的研究

Correlation of cranial MR and renal dysfunction in elderly patients with chronic renal insufficiency secondary to cerebrovascular disorder(CVD)

目的本研究旨在探讨老年肾功能不全继发脑血管疾病患者肾功能与头颅MR特征性改变的相关性以及患者头颅MR信号改变的影响因素。方法选择2015年4月—2016年4月我科住院的老年脑血管病患者103例,依据简化MDRD方程计算eGFR水平将患者进行分组,通过比较分析肾功能不全患者与对照组头颅MR腔隙灶、脑白质高信号的差异性,应用统计学分析方法,探讨老年脑小血管疾病MR病变程度与肾功能、年龄、血压等的相关性,从而推测肾功能不全患者继发脑血管疾病的危险因素。结果本研究患者的平均年龄(84.23±4.92)a,按e GFR<60 m L·min^(-1)·1.73 m^(-2)定义为肾功能不全组52例,肾功能正常组51例。组间患者腔隙灶数目、脑白质高信号评分、混合病变与否差异有统计学意义(P<0.05)。Logistic回归分析头颅MRI发生混合病变与年龄、高血压基础病、肾功能不全与否存在相关关系,且均为正相关。结论 (1)肾功能不全与头颅MRI的混合病变及严重脑白质高信号改变呈正相关,肾功能不全可反映头颅MRI的混合病变及脑白质高信号的严重程度。(2)年龄、高血压是脑小血管病的危险因素。

Objective To investigate the correlation of cranial MRI with renal insufficiency in elderly CVD patients, and find the risk factor of CVD. Methods 103 elderly patients with cerebrovascular disorder between April 2015 and April 2016 were identified in Guangzhou first people＇s hospital. Participants were grouped by the simplified MDRD equation based on eGFR levels, to confirm imaging results by detailed examination of cranial MRI. Lacunar lesions and White-matter hyperintensity were accessed and compared between renal dysfunction group and controlled group to identify the differences. Through statistical analysis, risk factors to cerebrovacular disease were considered. Results In the 103 elderly patients, the mean age of （84. 23 ± 4. 92） , had being divided into two groups according to eGFR 〈 60 ml · min-1· 1.73 m-22 ： renal insufficiency group （ n = 52） and normal renal function group （ n = 51 ）. There were statistical significance in the number of lacunar lesions, score of white-matter hyperintensity, mixed lesions between groups （P 〈 0. 05 ）. Logistic regression analysis showed a positive correlation between age, hypertension and renal insufficiency. Conclusion ①Renal insufficiency is posi- tively correlated with the mixed lesions and severe white-matter hyperintensity in cranial MRI, and could reflect its severity. ②Age and hypertension were risk factors for cerebral small vessel diseases.