2型糖尿病患者肾功能损伤程度与新发急性缺血性脑卒中的关系

Relationship between degree of renal function impairment and new-onset acute ischemic stroke in T2DM patients

目的探讨2型糖尿病(T2DM)患者肾损伤程度与新发急性缺血性脑卒中(AIS)的关系。方法选择有2次及以上住院史的T2DM患者269例,根据首次入院的血肌酐计算肾小球滤过率(eGFR),将其分为肾功能良好组181例(包括肾功能正常者和CKD 1~2期患者)、CKD 3期组65例、CKD 4~5期组23例。收集患者首次住院和末次住院时的头部MRI检查结果,评价是否存在新发AIS以及新发AIS的数量、大小和部位。采用单因素及多因素Cox回归模型分析T2DM患者肾损伤程度与AIS发生风险及梗死数量、大小、部位的相关性。结果所有入组对象中,新发AIS 58例,其中多发36例、单发22例;病灶最大直径≥1.0 cm 14例,<1.0 cm 44例;病灶位于双侧基底节区14例、丘脑4例、脑干15例、小脑13例、额叶20例、颞叶9例、顶叶14例、枕叶12例、岛叶2例。多因素Cox回归分析结果显示,CKD 4~5期组AIS发生风险较高(HR=3.229,95%CI为1.224~8.522,P=0.018)。三组AIS发生部位比较,CKD 4~5期组双侧基底节区发生AIS比例较高,CKD 3期组脑干发生AIS比例较高(P均<0.05)。CKD 3期组和CKD 4~5期组AIS病灶大小和数量比较差异均无统计学意义(P均>0.05)。结论T2DM患者中肾功能损伤与AIS风险增加相关且不同程度肾损伤新发AIS的部位存在差异;以血肌酐计算eGFR评估肾功能损伤程度,并以此预测T2DM患者的脑卒中发生风险具有一定的临床价值。

Objective To investigate the relationship between the degree of kidney damage and new-onset acute ischemic stroke(AIS)in patients with type 2 diabetes mellitus(T2DM).Methods Totally 269 T2DM patients with a history of 2 or more hospitalizations were selected.The estimated glomerular filtration rate(eGFR)was calculated based on the blood creatinine of the first admission,and they were divided into the good renal function group of 181 cases(including those with normal renal function and CKD stage 1 to 2 patients),the CKD stage 3 group of 65 cases,and the CKD stage 4 to 5 group of 23 cases.The clinical data and head MRI examination results of patients at the first hospitalization were collected to evaluate whether there were new-onset AIS,and the number,size and location of the new-onset AIS.Univariate and multivariate Cox regression analysis models were used to analyze the relationships between the degree of renal injury in T2DM patients and the risk of AIS,the number,size and location of infarctions.Results Among all the enrolled subjects,58 cases had new-onset AIS,of which 36 cases were multiple cases,22 cases were single cases;there were 14 cases with the largest lesions diameter≥1.0 cm,and 44 cases<1.0 cm;there were 14 cases with the lesion located in the bilateral basal ganglia,4 cases in the thalamus,15 cases in the brainstem,13 cases in the cerebellum,20 cases in the frontal lobe,9 cases in the temporal lobe,14 cases in the parietal lobe,12 cases in the occipital lobe,and 2 cases in the insular lobe.The results of multivariate Cox regression analysis showed that the risk of AIS in the CKD stage 4 to 5 group was higher(HR=3.229,95%CI 1.224-8.522,P=0.018).When we compared the locations of AIS in the three groups,the proportion of AIS in the bilateral basal ganglia of the CKD stage 4 to 5 group was higher,and the proportion of AIS in the brainstem of the CKD stage 3 group was higher(all P<0.05).There were no significant differences in the size and number of AIS lesions between the CKD stage 3 group and CKD stage 4 to 5 group(all P>0.05).Conclusion Renal injury in patients with T2DM is associated with increased risk of AIS and there are differences in the locations of newonset AIS patients with different degrees of kidney injury;calculating eGFR based on the blood creatinine to assess the degree of renal damage and then to predict the risk of stroke in T2DM patients has certain clinical value.