肾小球滤过率对急性大脑中动脉梗死患者肢体运动功能康复及短期预后的影响

Influence of estimated glomerular filtration rate in motor function rehabilitation and short-term prognoses in patients with acute middle cerebral artery infarction

目的探讨肾小球滤过率(eGFR)对急性大脑中动脉(MCA)梗死患者肢体运动功能康复及短期预后的影响。方法对自2016年3月至2018年9月于南京医科大学附属常州第二人民医院神经内科住院并转康复科行后续康复治疗4周的74例急性MCA梗死患者,于入院时采用中国改良简化肾脏病膳食改良试验方程计算eGFR以评估肾功能,并分为肾功能正常组和肾功能轻中度异常组;采用美国国立卫生研究院卒中量表(NIHSS)评分评估神经功能缺损程度;采用Fazekas量表评估脑白质疏松程度;采用简化Fugl-Meyer运动功能评分(FMA)评估康复治疗前及发病后90 d的肢体运动功能;采用改良Barthel指数(MBI)评估发病后90 d的日常生活活动能力,并以MBI是否>60分分为预后良好组和预后不良组;采用多因素Logistic回归分析筛选影响患者短期预后的危险因素。结果74例患者中肾功能正常者40例,肾功能轻中度异常者34例。肾功能轻中度异常组的尿素氮水平、陈旧性腔隙性脑梗死数量、Fazekas量表评分均明显高于肾功能正常组,发病后90 d FMA评分和MBI均明显低于肾功能正常组,差异均有统计学意义(P<0.05)。74例患者中预后良好者32例,预后不良者42例。多因素Logistic回归分析显示年龄、eGFR(OR=0.944,P=0.011,95%CI:0.903~0.987)、入院时NIHSS评分、Fazekas量表评分是影响患者短期预后的独立危险因素。结论急性MCA梗死患者eGFR的高低可影响肢体运动功能康复及短期预后。

Objective To investigate the influence of estimated glomerular filtration rate(eGFR)in rehabilitation of motor function and short-term prognoses in patients with acute middle cerebral artery(MCA)infarction.Methods Seventy-four patients with acute MCA infarction,admitted to Department of Neurology from March 2016 to September 2018,and then,accepted rehabilitation training for 4 weeks in Department of Rehabilitation medicine,were recruited.Modification of Diet in Renal Disease was used to evaluate the eGFR instead of renal function;according to the results,these patients were divided into normal renal function group and mild-moderate renal dysfunction group.National Institute of Health Stroke Scale(NIHSS)was used to assess the neurologic function.Fazekas scale was used to assess degrees of leukoaraiosis.Fugl-Meyer Motor Function Assessment(FMA)was used to assess motor functions before rehabilitation treatment and 90 d after onset.Modified Barthel Index(MBI)was used to assess activity of daily living 90 d after onset.According to MBI scores,the patients were divided into good prognosis group(MBI scores>60)and poor prognosis group(MBI scores≤60);multivariate Logistic regression analysis was used to confirm the risk factors affecting prognoses 90 d after onset.Results Among 74 enrolled patients,40 were classified as normal renal function group and 34 as mild-moderate renal dysfunction group;patients in the mild-moderate renal dysfunction group had significantly higher level of blood urea nitrogen,proportion of silent lacunar cerebral infarction and Fazekas scale scores,and had statistically lower FMA scores and MBI 90 d after onset than normal renal function group(P<0.05).Among the 74 patients,good prognosis was found in 32 patients and poor prognosis in 42 patients;multivariate Logistic regression analysis found that age,eGFR(OR=0.944,P=0.011,95%CI:0.903-0.987),baseline NIHSS scores,and Fazekas scale scores were risk factors affecting prognoses 90 d after onset.Conclusion In acute MCA infarction patients,eGFR can influence the rehabilitation of motor function and short-term prognoses.