肾小球滤过率与出血性脑卒中预后的关系研究

Relationship between glomerular filtration rate and prognosis of hemorrhagic stroke

目的探讨肾小球滤过率(estimated glomerular filtration rate,eGFR)与自发性脑出血(intracerebral hemorrhage,ICH)患者预后的关系。方法以首次因ICH、发病时间24h内住院的患者为研究对象,收集人口统计学、既往史、脑出血部位、入院后eGFR及其他临床资料。采用改良Rankin量表(modified Rankin Sacle,mRS)评估患者临床预后并分组。mRS评分≤2分定义为预后良好,mRS评分≥3分定义为预后不良。结果817例ICH患者中男528例(64.63%),年龄(54.41±11.99)岁。发病后1个月随访发现,68例(8.32%)预后良好,749例(91.68%)预后不良。单因素分析显示,预后不良组破入脑室(40.1%)显著高于预后良好组(20.6%),差异有统计学意义(χ~2=3.704,P=0.000);预后不良组GCS评分和eGFR显著低于预后良好组[(11.02±3.88)分vs(12.78±3.96)分;(81.41±33.54)mL/(min·1.73m^2)vs(105.7±28.1)mL/(min·1.73m^2)],差异有统计学意义(分别为t=3.518,P=0.001;t=6.685,P=0.000)。多变量Logistic回归分析显示,破入脑室比例升高[优势比(odds ratio,OR)2.577,95%置信区间(confidence interval,CI)1.406~4.723;P=0.002)],GCS评分降低(OR=4.133,95%CI2.343~7.292;P=0.000)和eGFR下降(OR=5.172,95%CI 2.863~9.344;P=0.000)是ICH患者临床预后不良的独立危险因素。结论eGFR下降至91.25 mL/(min·1.73 m^2)时灵敏度为76.5%,特异度为61.3%,能预测ICH患者的临床预后不良。

Objective To investigate the relationship between glomerular filtration rate （eGFR） and prognosis in patients with spontaneous cerebral hemorrhage （ICH）.Methods Demographics,past history,cerebral hemorrhage,post hospital eGFR and other clinical data were collected [rom patients who were hospitalized {or the [irst time within ICH and within 24 hours of onset. Patients＇ clinical outcomes were assessed and grouped using a modified Rankin SaNe （mRS）. The mRS score ≤ 2 score was de fined as a good prognosis,and the mRS score ≥3 score was defined as a poor prognosis. Results Among 817 patients with ICH, 528 （64.63%） were male,and the age was （54.41 ± 11.99） years old. One month after the onset of the disease, 68 patients （8.32%） had a good prognosis,and 749 patients （91.68Y00） had a poor prognosis. Univariate analysis showed that the poor prog nosis group broke into the ventricle （40.1%） significantly higher than the prognosis group （20.6%）,the difference was statisti cally significant （t =3. 704,P =0. 000） ;the poor prognosis group GCS score and eGFR were significantly lower In the prognosis group[（ll. 02±3.88） score vs （12.78±3.96） score;（81.41±33.54） mL/（min· 1.73 m2） vs （105.7±28.1） mL/（min · 1.73 m2）] ,the difference was Statistical significance （t =3. 518, P 0. 001 ;t= 6. 685, P =0. 000）. Multivariate Logistic regression a nalysis showed that the proportion of ruptured ventricles increased[odds ratio （OR） 2. 577,95% confidence interval （CI） 1. 406 4. 723;P 0.002],and the OCS score decreased （OR =4. 133,95Y00 CI 2. 343 7.292;P =0.000） and eGFR decreased （OR= 5. 172,95% CI 2.863 9.344;P= 0.000） were independent risk factors for poor clinical outcome in patients with lCH. Conclusion The eGFR decreased to 91.25 mL/（min · 1.73 m2） with a sensitivity of 76.5% and a specificity of 61.3%,which can predict the poor clinical prognosis of patients with ICH.