肾小球滤过率与小动脉闭塞性脑卒中进展的相关性研究

Relationship between eGFR and progressive small artery occlusion stroke

目的探讨估算的肾小球滤过率(eGFR)与小动脉闭塞性脑卒中(SAO)进展的相关性。方法选择2017年1月~2019年4月常州市第二人民医院神经内科住院的SAO患者93例,根据美国国立卫生研究院卒中量表(NIHSS)评分分为进展组33例及非进展组60例。比较进展组与非进展组危险因素,并进一步行多因素logistic回归分析eGFR在脑卒中进展中的作用。根据eGFR水平分为肾功能正常组50例及肾功能异常组43例,比较2组脑卒中进展、30 d预后及复发情况。结果进展组eGFR明显低于非进展组eGFR[(84.38±12.47)ml/(min·1.73 m2)vs(90.18±7.97)ml/(min·1.73 m2),P=0.008]。进展组发病7 d NIHSS评分明显高于非进展组,差异有统计学意义(P=0.000)。多因素logistic回归分析显示,eGFR是SAO进展的独立危险因素(OR=0.942,95%CI:0.899~0.987,P=0.012)。肾功能异常组发病7 d NIHSS评分、脑卒中进展、发病30 d改良的Rankin量表评分明显高于肾功能正常组,差异有统计学意义(P<0.05)。结论eGFR是SAO患者脑卒中进展的独立危险因素,eGFR异常的SAO患者脑卒中进展发生率高,并且30 d预后不良。

Objective To study the relationship between eGFR and progressive small artery occlusive(SAO).Methods Ninety-three SAO patients were divided into progressive SAO group(n=33)and non-progressive SAO group(n=60)according to their NIHSS score.The risk factors for SAO were compared between the two groups.The role of eGFR in inducing progressive SAO was analyzed by multivariate logistic regression analysis.The patients were further divided into normal renal function group(n=50)and abnormal renal function group(n=43)according to their eGFR.The progression,outcome and recurrence of SAO on day 30 after onset of SAO were compared between the two groups.Results The eGFR was significantly lower in progressive SAO group than in non-progressive SAO group(84.38±12.47 ml/min·1.73 m^2 vs 90.18±7.97 ml/min·1.73 m^2,P=0.008).The NIHSS score was significantly higher in progressive SAO group than in non-progressive SAO group on day 7 after onset of SAO(P=0.000).Multivariate logistic regression analysis showed that eGFR was an independent risk factor for progressive SAO(OR=0.942,95%CI:0.899-0.987,P=0.012).The NIHSS score on day 7 after onset of SAO,the incidence of SAO and mRS score on day 30 after onset of SAO were significantly higher in abnormal renal function group than in normal renal function group(P<0.05).Conclusion eGFR is an independent risk factor for progressive SAO.The incidence of progressive SAO is high in abnormal eGFR patients with a poor outcome on day 30 after onset of SAO.