老年轻型卒中患者的肾功能与脑小血管病总负荷相关性分析

The correlation between renal function and the total cerebral small vessel disease score in elderly patients with a mild stroke

目的探讨老年轻型卒中患者的肾功能与脑小血管病(CSVD)总负荷的相关性.方法连续入选2019年3-12月在南京医科大学附属常州市第二人民医院住院治疗的轻型卒中(美国国立卫生研究院卒中量表评分≤3分)老年患者.依据扩大的血管周围间隙、脑微出血、血管起源的白质高信号及血管起源的腔隙出现的情况,评估患者的CSVD总负荷,使用美国慢性肾脏病流行病学协作组的肌酐方程(CKD-EPI_(scr))估算肾小球滤过率(eGFR),分析eGFR与CSVD总负荷之间的关系.结果共纳入152例患者,其中CSVD总负荷评分为0、1、2、3和4分的患者分别有35例、38例、39例、28例和12例.CSVD总负荷评分越高(0~4分),患者的年龄越大[(67.43±6.59)岁、(68.42±6.83)岁、(72.18±7.94)岁、(76.46±7.75)岁、(79.92±6.17)岁;F=12.018,P<0.001],eGFR值越小[(92.94±12.45)、(90.52±8.62)、(89.45±8.48)、(83.90±7.19)、(79.16±7.77)ml·min^(-1)·1.73m^(-2);F=7.210,P<0.001].Spearman相关分析发现,eGFR与CSVD总负荷呈负相关(r=-0.399,P<0.001).进一步多因素有序Logistic回归分析发现,在校正年龄、性别、高血压等危险因素后,eGFR的下降是CSVD总负荷增加的危险因素(OR=0.957,95%CI=0.924~0.990,P=0.012).结论在老年轻型卒中患者中,eGFR是CSVD总负荷的独立危险因素,随着eGFR水平下降,CSVD总负荷加重.

Objective To investigate the relationship between renal function and the total cerebral small vessel disease(CSVD)score in elderly patients with a mild stroke.Methods Patients with a mild stroke(National Institutes of Health Stroke Scale score≤3)and aged 60 years and above hospitalized in our hospital from March to December 2019 were consecutively enrolled.Total CSVD scores were evaluated based on enlarged perivascular spaces-cerebral microbleeds,white matter hyperintensities of presumed vascular origin and lacunes of presumed vascular origin.The estimated glomerular filtration rate(eGFR)was derived by using the formula of chronic kidney disease epidemiology collaboration based on serum creatinine(CKD EPI_(scr)).The relationship between eGFR and the total CSVD score was analyzed.Results.Of the 152 patients enrolled,35,38.39.28 and 12 had total CSVD scores of 0.1.2.3 and 4,respectively.The age of patients increased and eGFR decreased with the inerease of total CSVD scores(CSVD from 0 to 4,[(67.43±6.59),(68.42±6.83),(72.18±7.94),(76.46±7.75)us.(79.92±6.17)years old.F=12.018,P<0.001];[(92.94±12.45)ml·min^(-1)·1.73m^(-2).(90.52±8.62)ml·min^(-1)·1.73m^(-2),(89.45±8.48)ml.min^(-1)·1.73m^(-2)and(83.90±7.19)ml·min^(-1)·1.73m^(-2)us.(79.16±7.77)ml·min^(-1)·1.73m^(-2).F=7.210.P<0.001].Spearman crrelation analysis showed that eGFR was negaively crrelated with the total CsVD score(r=-0.399,.p<0.001).After adjusting for risk factors including age.gender and hyertension.multivariate ordinary rgresson analysis showed that decreased eGFR was an independent risk factor for the total CSVD score(OR=0.957.95%CI:0.924-0.990.P=0.012).Conclusions ln elderly patients with a mild stroke.eGFR is an independent risk factor for the total CSVD score.which shows an increased burden as eGFR decreases.