西安地区中青年急性卒中患者肾小球滤过率估计值与1年死亡的关系研究

The Relationship between eGFR and 1-Year Mortality in Young and Middle-aged Patients with Acute Stroke in Xi’an

目的探讨西安地区中青年急性卒中患者肾小球滤过率估计值(estimated glomerular filtration rate,eGFR)水平与1年死亡的关系。方法基于西安卒中登记研究数据库平台,回顾性分析西安市4所三级甲等医院2015年1-12月连续入院的急性卒中患者的临床和随访资料,筛选出年龄在18~64岁的中青年急性卒中患者。将eGFR按照从低到高的水平排序后进行5等分组(Q1~Q5),比较不同eGFR水平组间临床特征和1年全因死亡率的差异;通过多因素Cox回归分析,探讨中青年急性卒中患者eGFR水平与1年全因死亡的关系,并采用Kaplan-Meier法进行不同eGFR水平组的生存分析。结果最终纳入中青年急性卒中患者1405例,平均年龄53.9±8.0岁,男性961例(68.4%),女性444例(31.6%)。校正相关混杂因素后,多因素Cox回归分析显示,eGFR水平每升高5 mL/(min·1.73 m^(2)),中青年急性卒中患者的1年死亡风险降低8%(HR 0.92,95%CI 0.87~0.97,P=0.002);与Q5组[>92.5 mL/(mi n·1.73 m^(2))]相比,eGFR处于Q1组[<69.6 mL/(min·1.73 m^(2))]患者的1年死亡风险升高1.40倍(HR 2.40,95%CI 1.02~5.67,P=0.045),其他eGFR水平组的1年死亡风险无显著性增加。生存分析发现,与其他eGFR水平组相比,Q1组的生存率明显下降(Q1组89.7%vs.Q2组96.8%,Q3组94.4%,Q4组97.9%,Q5组96.1%),差异有统计学意义(P<0.001)。结论eGFR水平降低是中青年急性卒中患者1年死亡的独立危险因素,eGFR<69.6 mL/(min·1.73 m^(2))可显著增加中青年急性卒中患者的1年死亡率。

Objective To investigate the relationship between estimated glomerular filtration rate(eGFR)and 1-year mortality in young and middle-aged patients with acute stroke in Xi’an.Methods Based on the Xi'an Stroke Register database,the clinical and follow-up data of patients with acute stroke from four“AAA”hospitals in Xi’an from January to December 2015 were retrospectively analyzed.Young and middle-aged patients aged between 18 and 64 years were selected.All the subjects were divided into 5 groups(Q1-Q5)according to the quintile of eGFR,and the clinical characteristics and 1-year all-cause mortality among the 5 groups were compared.Multivariate Cox regression analysis was performed to analyze the relationship between eGFR and 1-year mortality in young and middle-aged patients with acute stroke.Kaplan-Meier survival curve analysis was used to analyze the survival of the 5 groups.Results A total 1405 eligible patients were enrolled in this study,with a mean age of 53.9±8.0 years old and 961 males(68.4%).After adjustment for the related confounders,multivariate Cox regression analysis showed that 1-year mortality in young and middle-aged patients with acute stroke decreased by 8%per 5 mL/(min·1.73 m^(2))increase in eGFR(HR 0.92,95%CI 0.87-0.97,P=0.002);compared with the Q5 group[eGFR<69.6 mL/(min·1.73 m^(2))],1-year mortality increased by 1.40 times(HR 2.40,95%CI 1.02-5.67,P=0.045)in Q1 group[<69.6 mL/(min·1.73 m^(2))],while there was no significant increase in 1-year mortality in other 3 groups.Kaplan-Meier survival analysis found a significant decrease in survival rate in the Q1 group compared to the other groups(Q1:89.7%vs.Q2:96.8%,Q3:94.4%,Q4:97.9%,Q5:96.1%),all with statistical differences(P<0.001).Conclusions Decreased eGFR level is an independent risk factor for 1-year mortality in young and middle-aged patients with acute stroke,and eGFR<69.6 mL/(min·1.73 m^(2))was associated with an obvious increase in 1-year mortality.