急性肾损伤与缺血性脑卒中患者rt-PA溶栓预后相关性分析

Analysis of the Correlation between Acute Kidney Injury and the Prognosis of Ischemic Stroke Patients with rt-PA Thrombolytic Therapy

目的:分析急性肾损伤(AKI)对rt-PA溶栓治疗缺血性脑卒中(AIS)患者预后的影响,并探讨急性缺血性脑卒中与AKI发生的相关性。方法:选取2018年1月—2020年10月间我院收治急性缺血性脑卒中在时间窗内行rt-PA溶栓治疗的患者127例作为研究对象,收集患者一般资料、基础疾病、溶栓治疗前的生化结果、NIHSS评分、APACHEⅡ评分、改良Rankin评分等指标,统计住院时间和费用。根据是否发生AKI分为AKI组和无AKI组,采用单因素和多因素Logistics回归的方法分析AKI的危险因素。结果:127例患者中19例(14.96%)出现AKI,AKI组APACHEⅡ评分、改良Rankin评分、住院时间和费用情况均高于无AKI组患者,差异具有统计学意义(P<0.05)。单因素分析显示两组患者间高血压、糖尿病基础疾病,肌酐、估计肾小球滤过率(eGFR)水平,NIHSS评分,GCS评分之间存在差异(P<0.05)。多因素Logistics回归分析结果显示肌酐升高、eGFR下降以及NIHSS评分升高是影响AKI发生的危险因素(P<0.05)。结论:rt-PA溶栓治疗缺血性脑卒中发生AKI将直接影响到患者的预后和转归,AKI的发生与患者基础肾功能以及卒中的严重程度呈正相关。

Objective:To analyze the effect of acute kidney injury(AKI)on the prognosis of patients with ischemic stroke(AIS)treated with rt-PA thrombolysis,and to explore the risk factors of AKI.Methods:127 cases of AIS patients received rt-PA thrombolysis treatment in our hospital during January 2018 to October 2020 were recruited,collect patients’general information,basic diseases,biochemical results before thrombolysis treatment,NIHSS score,APACHEⅡscore,modified Rankin scale indicators and hospitalization time.Patients were divided into AKI group and non-AKI group according to whether AKI occurred or not.The risk factors of AKI were analyzed by single factor and multi-factor logistics regression method.Results:AKI was present in 19(14.96%)of 127 patients.The APACHEⅡscore,modified Rankin scale,length of hospital stay and costs in AKI patients were higher than non-AKI group patients,the difference were statistically significant(P<0.05).Univariate analysis showed differences in hypertension,diabetes,creatinine,estimated glomerular filtration rate(eGFR),NIHSS score,and GCS score between the two groups(P<0.05).The results of multi-factor logistics regression analysis showed that increased creatinine,decreased eGFR and increased NIHSS score were risk factors for AKI(P<0.05).Conclusion:The happenings of AKI in AIS patients treated with rt-PA thrombolysis will directly affect the prognosis and outcome of patients.The occurrence of AKI is related to the basic renal function and the severity of stroke.The focus of clinical work should be early screening and preventive intervention to reduce the risk of the occurrence of AKI.