急性缺血性卒中患者入院eGFR水平与短期预后不良关系的研究

Study of the relationship between estimated glomerular filtration rate levels on admission and short-term poor prognosis in patients with acute ischemic stroke

目的探讨急性缺血性卒中患者(AIS)入院肾小球滤过率估算值(eGFR)与3个月预后不良的关系。方法基于西安卒中登记研究数据库,连续纳入西安市4所三级甲等医院住院的AIS患者临床特征和3个月随访相关资料。分别将eGFR按照连续性变量和四分组变量(Q1~Q4)处理。比较各组患者的eGFR临床特征差异;采用曲线拟合和多因素Logistic回归分析,探讨AIS患者入院eGFR水平与3个月预后不良的关系。结果最终纳入AIS患者2280例,年龄(64.2±12.2)岁,男1426例(62.5%)。校正相关混杂因素后,多因素Logistic回归分析显示,eGFR水平每升高5 mL·min^(-1)·(1.73 m^(2))-1,3个月预后不良风险降低5.0%(OR=0.95,95%CI:0.94~0.99,P=0.028),曲线拟合显示,随着e GFR水平的升高,3个月预后不良的风险呈先下降再升高的趋势。与Q1相比,Q3组患者3个月预后不良风险降低44.0%,差异有统计学意义(OR=0.56,95%CI:0.38~0.82,P=0.003),Q2组和Q4组患者3个月预后不良的风险降低差异无统计学意义。改良Rankin量表(modified Rankin scale,mRS)评分比例分布图显示,3个月预后不良患者中Q3和Q4组AIS患者中mRS>3分的比例均明显降低。结论低水平的eGFR是AIS患者短期预后不良的独立危险因素,早期干预e GFR在适当的范围内,可能会降低AIS患者短期预后不良的风险。

Objective To investigate the relationship between estimated glomerular filtration rate(eGFR)and poor prognosis at 3 months in patients with acute ischemic stroke(AIS).Methods Based on the Xi’an Stroke Registry Study Database,the clinical characteristics and 3-month follow-up data of patients with AIS who were admitted to four A tertiary hospitals in Xi’an were included.The eGFR was treated as a continuous variable and categorical variable(Q1-Q4),respectively.The clinical characteristics of patients with eGFR levels were com⁃pared between Q1-Q4 group.Curve fitting and multivariate Logistic regression analysis were used to investigate the relationship between eGFR level and poor prognosis at 3 months in patients with AIS.Results A total of 2280 AIS patients were included in this study,with an average age of(64.2±12.2)years old and 1426 males(62.5%).After adjusting for confounding factors,multivariate Logistic regression analysis showed that for every 5 mL·min^(-1)·(1.73 m^(2))^(-1)increase in eGFR level,the risk of poor prognosis at 3 months was reduced by 5.0%(OR=0.95,95%CI:0.94-0.99,P=0.028).Curve fitting showed that the risk of poor prognosis at 3 months de⁃creased first and then increased with the increase of eGFR level.Compared with Q1 group,patients in Q3 group had a 44.0%lower risk of poor prognosis at 3 months(OR=0.56,95%CI:0.88-0.82,P=0.003),while patients in Q2 and Q4 groups had no significant reduction in the risk of poor prognosis at 3 months.The proportion distribu⁃tion of modified Rankin scale(mRS)scores showed that the proportion of mRS>3 in Q3 and Q4 groups was sig⁃nificantly reduced in patients with poor prognosis at 3 months.Conclusion Low level of eGFR is an independent risk factor for short-term poor prognosis in patients with AIS.Early intervention with eGFR in the appropriate range may reduce the risk of short-term poor prognosis in patients with AIS.