脑出血并发脑微出血患者的肾脏损伤标志物研究  

Biomarkers of renal injury in cerebral hemorrhage patients with cerebral microbleeds

作　　者：杨亚超[1] 刘英霞[2] 张江山[2] 张金彪[2] 

机构地区：[1]山东省滨州医学院附属威海市立医院内分泌科,264200 [2]山东省滨州医学院附属威海市立医院神经内科,264200

出　　处：《中华神经科杂志》2015年第6期469-474,共6页Chinese Journal of Neurology

摘　　要：目的 探讨脑出血患者肾脏损伤标志物水平与脑微出血的相关性.方法 横断面研究了129例脑出血患者,应用3.0T磁共振磁敏感加权成像确定是否存在脑微出血;根据简化肾脏病膳食改良试验公式推算其肾小球滤过率,应用免疫比浊法检测尿中微量白蛋白含量,尿肌酐应用酶法检测,应用颗粒增强免疫比浊法测定胱抑素C水平.结果 129例脑出血患者中有86例（66.7％）存在脑微出血.与不存在脑微出血患者相比,存在脑微出血的脑出血患者被评估的肾小球滤过率（ml ·min^-1· 1.73 m^-2）水平明显降低（非脑微出血组为78.07±18.69,脑微出血组为61.59±17.08,t =3.672,P＜0.01）,尿白蛋白与肌酐比值（mg/g;非脑微出血组为20.47±9.03,脑微出血组为35.24±14.83,t=3.823,P＜0.01）和胱抑素C的水平（mg/L;非脑微出血组为0.98±0.09,脑微出血组为1.31±0.13,t=4.739,P＜0.01）明显增高.多变量Logistic分析表明：在脑出血患者中校正年龄、性别、高血压、糖尿病、高脂血症、吸烟、喝酒、腔隙性脑梗死及脑白质疏松及超敏C反应蛋白后,肾脏损伤标志物水平（被评估的肾小球滤过率、尿白蛋白与肌酐比值及胱抑素C）的改变仍伴随脑微出血的存在,其比值比（95％ CI）分别为2.573 （1.172～5.315）、2.735 （1.247 ～6.246）和2.976（1.764～6.968）.胱抑素C对脑微出血有较好的诊断价值,其曲线下面积为0.835 （95％CI0.791 ～0.878）;被评估的肾小球滤过率水平的减低伴随着脑微出血数量的增加（P=0.038,R2 total=0.216）,尿白蛋白与肌酐比值和血清胱抑素C水平的增加也伴随着脑微出血数量的增加（P=0.024,R2 total =0.312;P=0.013,R2 total=0.375）.结论 脑出血患者的肾脏损伤标志物水平与脑微出血的存在具有相关关系,且与脑微出血的数量具有相关性.胱抑素C有可能成为脑出血患者存在脑微出血的标志.Objective To investigate the relationship between biomarkers of renal function and cerebral microbleeds （CMBs） in cerebral hemorrhage patients.Methods This is a cross-sectional study including a total of 129 patients with cerebral hemorrhage.All patients underwent susceptibility weighted 3.0 T MRI.The presence and number of CMBs on susceptibility weighted MRI were independently interpreted.We calculated the urinary albumin/creatinine ratio （UACR） from morning spot urine and the estimated glomerular filtration rate （eGFR） in serum samples.Serum cystatin C （CysC） was measured using the automated particle-enhanced turbidimetric immunoassay.Results Among 129 patients with cerebral hemorrhage,86 （66.7%） had CMBs on susceptibility-weighted imaging.UACR （mg/g;20.47 ± 9.03 vs 35.24±14.83,t=3.823,P〈0.01）andCysC （mg/L;0.98±0.09vs 1.31 ±0.13,t=4.739,P〈0.01） levels were higher in the patients with CMBs than those without,and the eGFR （ml · min^-1 · 1.73 m^2） was lower in the patients with CMBs than those without （78.07 ± 18.69 vs 61.59 ± 17.08,t =3.672,P 〈0.01）.A Logistic regression analysis indicated that the levels of kidney impairment biomarkers were significantly associated with the prevalence of CMBs in cerebral hemorrhage patients after an adjustment for age,sex and other risk factors.The odds ratio （OR） and 95% CI of each kidney biomarkers （eGFR,UACR,and CysC） for the CMBs status were 2.573 （1.172-5.315）,2.735 （1.247-6.246）and 2.976 （1.764-6.968）,respectively.CysC exhibited fair diagnostic value for CMBs,with an area under the curve of 0.835 （95% CI 0.791-0.878）.Furthermore,there were negative correlations between eGFR and the the number of CMBs （P =0.038,R2 total =0.216）.There was a positive correlation between UACR,CysC and number of CMBs （P =0.024,R2 total =0.312;P =0.013,R2 total =0.375）.Conclusions Elevated levels of kidney biomarkers are associated with the presence of CMBs in cerebral hemorrhage patients,independent of conventiona

关 键 词：脑出血 肾小球滤过率 白蛋白尿 半胱氨酸蛋白酶抑制物C 生物学标记 

分 类 号：R743.34[医药卫生—神经病学与精神病学]