慢性肾脏病与扩大的血管周围间隙相关性研究

Association between chronic kidney disease and dilated Virchow-Robin space

目的探讨急性腔隙性脑梗死患者慢性肾脏病(CKD)与扩大的血管周围间隙(dVRS)的关系。方法选择于我院神经内科住院的急性腔隙性脑梗死患者1078例,根据患者在基底节区与在半卵圆中心区的dVRS严重程度分别分为2组,在基底节区,轻度1组737例,中重度1组341例;在半卵圆中心区,轻度2组789例,中重度2组289例。估算肾小球滤过率评价肾功能水平,并将CKD分为1期、2期、3a期及3b期。采用多因素logistic回归分析肾功能与dVRS严重程度的相关性。结果中重度1组年龄、女性、高血压及CKD发生率明显高于轻度1组,吸烟比例明显低于轻度1组,差异有统计学意义(P<0.01);中重度2组高血压发生率明显高于轻度2组,差异有统计学意义(P<0.05)。logistic回归分析显示,年龄(OR=1.089,P=0.00)、高血压(OR=1.796,P=0.00)、2期CKD(OR=3.296,P=0.02)、3a期CKD(OR=2.721,P=0.03)、3b期CKD(OR=3.408,P=0.02)是基底节区中重度dVRS的独立危险因素。仅高血压(OR=1.365,P=0.04)是发生半卵圆中心区中重度dVRS的独立危险因素。结论在急性腔隙性脑梗死患者中,CKD是基底节区中重度dVRS的独立危险因素,而与半卵圆中心区dVRS无明显相关性,基底节区与半卵圆中心区dVRS可能具有不同的病理生理机制及危险因素。

Objective To study the association between chronic kidney disease（CKD）and dilated Virchow-Robin space（dVRS）in acute lacunar ischemic stroke patients.Methods A total of 1078 acute lacunar ischemic stroke patients admitted to our hospital were divided into mild dVRS group 1（n=737）and moderate-severe dVRS group 1（n=341）according to the severity of their dVRS in basal ganglia（BG）,and into mild dVRS group 2（n=789）and moderate-severe dVRS group 2（n=289）according to the severity of their dVRS in centrum semiovale（CSO）.Their kidney function was assessed according to the estimated glomerular filtration rate（eGFR）.CKD was classified into stage 1,stage 2,stage 3 aand stage 3 b.The association between renal function and dVRS was analyzed by multivariate logistic regression analysis.Results The age was older,the number of females was greater,the incidence of hypertension and CKD was higher,the proportion of smoking was lower in moderate-severe dVRS group 1 than in mild dVRS group 1（P〈0.05）.The incidence of hypertension was higher in moderate-severe dVRS group 2 than mild dVRS group 2（P〈0.05）.Multivariate logistic regression analysis showed that age,hypertension,stage 2 CKD,stage 3 aCKD and stage 3 bCKD were the independent risk factors for severe dVRS in BG（P〈0.05,P〈0.01）.Hypertension was an independent risk factor for severe dVRS in CSO（P=0.04）.Conclusion CKD is an important risk factor for dVRS in BG.However,it is not associated with dVRS in CSO.This result highlights the different pathological mechanisms and risk factors for dVRS in BG and CSO.