糖尿病肾病合并缺血性脑卒中的临床表现及预后分析

Clinical Features and Prognosis of Patients with Ischemic Stroke Superimposed on Diabetic Kidney Disease

目的观察分析糖尿病肾病(DKD)患者合并缺血性脑卒中(简称脑卒中)发病情况及合并脑卒中对肾脏预后的影响。方法选取2013年7月一2017年6月住院的DKD患者129例,收集患者的一般资料及实验室检查结果等,根据是否合并脑卒中分为脑卒中组(.=27)和非脑卒中组(.=102),比较两组的临床资料,并进行预后分析。结果按照CKD分期,各期中脑卒中发生率分别为:1期11.6%,2期18.2%,3期26.7%,4期31.3%,5期42.9%。脑卒中组患者年龄、糖尿病病程、高血压病程、24h尿蛋白定量、血清肌酹及总胆固醇水平均高于非脑卒中组,血清白蛋白及eGFR水平低于非脑卒中组患者。与非脑卒中组相比,脑卒中组患者的平均动脉压及脉压差水平偏高,糖尿病视网膜病变和心血管疾病发生率也较高。经Kaplan-Meier法计真,脑卒中组的肾脏预后较非脑卒中组的肾脏预后差。经多因素COX分析,合并脑卒中不独立影响入组患者的肾脏预后。结论随着肾功能水平下降,脑卒中发生率逐渐升高。与不合并脑卒中者相比,DKD合并脑卒中患者年龄较大,糖尿病病程、高血压病程较长,临床病情更重.合并症更多见。然而,脑卒中未独立影响DKD患者的肾脏预后。

Objective To observe the clinical features and prognosis of patients with ischemic stroke superimposed on diabetic kidney disease (DKD). Methods We selected 129 patients with DKD in our hospital from July 2013 to June 2017. DKD patients were divided into the stroke group (27 cases) and the non-stroke group (102 cases). The clinical data and laboratory results of patients were collected and analyzed. Results According to the stage of CKD, the incidence of stroke in each stage were as follows: 11.6% in stage 1, 18.2% in stage 2, 26.7% in stage 3, 31.3% in stage 4 and 42.9% in stage 5. The age, the duration of diabetes and hypertension, the level of urine protein, serum creatinine and total cholesterol of the stroke group were higher than those of the nonstroke group. The level of eGFR and serum albumin were lower than those of the non-stroke group. The level of mean arterial pressure and pulse pressure in the stroke group were significantly higher than those in the non-stroke group. The incidence of diabetic retinopathy and cardiovascular disease in the stroke group was higher than that in the non-stroke group. The kidney prognosis of the stroke group was worse than that of the non-stroke group by Kaplan-Meier method. By multifactor COX analysis, ischemic stroke was not an independent risk factor for renal prognosis in these patients. Conclusion With the decline of renal function, the incidence of stroke increased. Compared with those without stroke, DKD patients combined with stroke has a larger age, longer duration of diabetes and hypertension, more severe condition and more complications. However, ischemic stroke did not independently affect the prognosis of the patients.