慢性肾脏病与急性脑梗死患者长期预后的关系  

Correlation between chronic kidney disease and long-term outcome in patients with acute cerebral infarction

作　　者：李慎军[1] 胡怀强[1] 胥文娟[1] 曹秉振[1] 

机构地区：[1]济南军区总医院神经内科,250031

出　　处：《中华神经科杂志》2015年第4期279-283,共5页Chinese Journal of Neurology

摘　　要：目的探讨慢性。肾脏病（CKD）与急性脑梗死患者长期预后的关系。方法前瞻性收集2010年8月至2013年11月于济南军区总医院神经内科住院的急性脑梗死患者，记录其年龄、性别、血清肌酐、美国国立卫生研究院卒中量表（NIHSS）评分等基线资料。根据美国慢性肾脏疾病流行病学合作组织（CKD-EPI）公式计算估测肾小球滤过率（eGFR）。将eGFR〈60ml·min^-1·1．73m^-2体表面积定义为肾功能不全，提示有CKD。按照eGFR的水平将患者分为eGFR≥60ml·min^-1·1．73m^-2和eGFR〈60ml·min^-1·1．73m^-2两组。在发病后180d通过电话进行随访，采用改良Rankin量表（mRS）评分对患者的预后进行评价（mRS评分≤2分为预后良好，mRS评分〉2分为预后不良）。采用多元回归、卡普兰一迈耶生存曲线分析伴CKD急性脑梗死患者预后不良的风险比和病死率。结果共纳入852例急性脑梗死患者，eGFR≥60ml·min^-1·1．73m^-2组759例，eGFR〈60ml·min^-1·1．73m^-2／12组93例。与无CKD患者相比，伴有CKD的急性脑梗死患者年龄偏大[（70．56±11．86）岁与（63．11±12．15）岁，t=5．60，P=0．000]，NIHSS评分≥7分的比例较高[59．14％（55／93）与32．54％（247／759），X^2=25．61，P=0．000]，患高血压病[89．25％（83／93）与77．34％（587／759），X^2=6．99，P=0．007]、心房颤动[29．03％（27／93）与9．5％（72／759），X^2=30．82，P=0．000]、心力衰竭[13．98％（13／93）与3．03％（23／759），X^2=24．54，P=0．000]、肿瘤[6．50％（6／93）与2．24％（17／759），X^2=5．59，P=0．031]的比例较高。CKD是急性脑梗死患者预后不良（OR=2．034，95％CI1．194-3．468）、病死率高（OR=2．657，95％CI 1．450～4．870）的独立预测因子。与不伴CKD患者相比，伴有CKD的患者生存率低[79．57％（74／93）与93．54％（710／759）；时序检验：X^2=23．602，P=0．000]。结论伴有CObjective To investigate the correlation between chronic kidney disease （CKD） and long-term outcomes in a large cohort of unselected patients with acute cerebral infarction. Methods Consecutive acute cerebral infarction patients hospitalized in Department of Neurology, General Hospital of Jinan Military Region were prospectively recruited from August 2010 to November 2013. The baseline data including age, sex, the National Institute of Health Stroke Scale （NIHSS） scores, type of Oxfordshire Community Stroke Project （OCSP： total anterior circulation infarct, partial anterior circulation infart, posterior circulation infarct and lacunar infarct）, serum creatinine were recorded. Estimated glomerular filtration rate （eGFR） was calculated according to CKD epidemiology collaboration （CKD-EPI） equation. CKD was defined as eGFR 〈 60 ml ^-1·1.73m^-2 body surface area. Patients were divided into eGFR≥60 ml ^-1·1.73m^-2group and eGFR 〈 60 ml^-1·1.73m^-2 group. Recovery was assessed by modified Rankin Scale （mRS） 180 days after stroke by telephone interview （mRS--〈2 reflected good prognosis, and mRS 〉 2 reflected unfavorable prognosis）. Multinominal Logistic regression analysis,Kaplan-Meier curve and log rank test were used. Results Eight hundred and fifty-two patients were enrolled, among them 93 patients were with CKD. Compared to patients without CKD, acute ischemic patients with CKD were older （ （70. 56 ± 11.86） years vs （63.11± 12. 15） years,t =5.60, P =0. 000）, more likely with NIHSS ≥7 （59. 14% （55/93） vs 32. 54% （247/759）, X^2 = 25.61, P = 0. 000）, more likely with hypertension （89. 25% （83/93） vs 77.34% （587/759）, X^2 = 6. 99, P = 0. 007）, more likely with atrial fibrillation （29. 03% （27/93） vs 9. 5% （72/759）, X^2 =30. 82,P =0. 000）, more likely with congestive heart failure （ 13.98% （ 13/93 ） vs 3.03% （23/759）, X^2 = 24. 54, P = 0. 000）, more likely with tumour （6. 50% （ 6/93 ） vs 2. 24% （ 17/759）,

关 键 词：肾功能不全 慢性 脑梗死 预后 

分 类 号：R692[医药卫生—泌尿科学] R743.3[医药卫生—外科学]