慢性肾脏病与缺血性卒中短期预后的关系

Correlation between Chronic Kidney Disease and Short-Term Outcome in Patients with Cerebral Ischemic Stroke

目的探讨慢性肾脏病(CKD)与缺血性卒中(CIS)短期预后的关系。方法收集2011年1月至2015年3月巴中市中心医院神经内科收治的CIS患者103例,记录其年龄、性别、血清肌酐、美国国立卫生研究院卒中量表(NIHSS)评分等基线资料。根据肾小球滤过率(eGFR)水平将患者分为有CKD(34例,eGFR≥60 mL·min^(-1)·1.73m^(-2))组和无CKD(69例,eGFR<60mL·min^(-1)·1.73m^(-2))组;根据改良Rankin量表(mRS)评分将患者分为预后良好(62例,mRS评分≤2分)组和预后不良(41例,mRS评分>2)组,对各组临床病理特征进行比较,应用logistic进行伴发CKD和CIS预后不良的危险因素回归分析。结果多因素Logistic回归分析显示:高血压、糖尿病、蛋白尿和IMT≥1.3mm均为急性CIS伴发CKD的独立危险因素(OR分别为2.273、1.237、1.308、1.347,均P<0.05),而IMT<1.0mm则是独立保护因素(OR0.443,P<0.05)。糖尿病、糖尿病前期、CKD(eGFR<60mL·min^(-1)·1.73m^(-2))、蛋白尿均为急性CIS预后不良的独立危险因素(OR分别为1.497、1.420、2.051、2.546,均P<0.05)。结论伴有CKD的CIS患者共存病较多,CKD是CIS预后不良的独立危险因素之一,且与CIS的部分危险因素密切相关,并对CIS短期预后有着显著的影响。

Objective To investigate the correlation between chronic kidney disease(CKD) and short-term outcome in patients with cerebral ischemic stroke(CIS). Methods We retrospectively analyzed the clinical data of 103 patients with CIS who were treated in the Department of Neurology of Bazhong Central Hospital from January 2011 to March 2015 , including the age,gender, serum creatinine and NIHSS score, etc. According to the estimated glomerular filtration rate(eGFR),patients were divided into CKD group(eGFR<C60 mL ? min-1 ? 1. 73 m-2 ,n = 34) and non-CKD group (eGFR>6〇 mL ? min—1 ? 1. 73 m—2,n = 69). According to the modified Rankin scale(mRS) scores, patients were divided into good outcome group(mRS^2 62) and poor outcomegroup(mRS>2, n = 41). The clinicopathologic features were compared between different groups.The independent factors for CKD and poor outcome of CIS were analyzed by logistic regression analysis.Results Multivariate logistic regression analysis showed that hypertension,diabetes,albuminuria and IM T ^l. 3 mm were the independent risk factors for CIS complicated by CKD(QR = 2. 273,1. 237,1. 308 and 1. 347,respectively;P<C0. 05). However, IMT<C1. 0 mm was the protective factor for CIS complicated by CKD (OR —0. 443,P<C0. 05). The diabetes, prediabetes, CKD (eGFR<C 60 mL ? min-1 ? 1. 73 m-2) and albuminuria were the in dependent risk factors for poor outcome inpatients with CIS(QR = 1. 497,1. 420,2. 051 and 2. 546, respectively; _P〈0. 05). Conclusion CIS patients with CKD have multiple comorbidities. CKD is one of the independent risk factors for poor outcome of CIS. It is closely associated with some risk factors for CIS and has a significant impact on short-outcome of CIS.