心肾功能对急性脑卒中早期神经功能恢复的影响  

Effects of cardiac function and renal function on early neurological function recovery in patients with acute stroke

作　　者：张爱玲 许珂[1] 邢海英[1] 孙葳[1] 彭清[1] 李凡[1] 黄一宁[1] 孙伟平[1] 刘冉[1] 舒俊龙[1] Zhang Ailing;Xu Ke;Xing Haiying;Sun Wei;Peng Qing;Li Fan;Huang Yining;Sun Weiping;Liu Ran;Shu Junlong(Department of Neurology,Peking University First Hospital,Beijing 100034,China;the Department of Neurology,People′s Hospital of Zhengzhou)

机构地区：[1]北京大学第一医院神经内科,100034 [2]郑州人民医院神经内科

出　　处：《中华神经科杂志》2019年第6期463-471,共9页Chinese Journal of Neurology

摘　　要：目的探讨心功能和肾功能对急性脑卒中患者早期神经功能恢复的影响。方法收集2010年1月至2018年5月在北京大学第一医院神经内科收治的急性脑卒中患者,根据出院改良Rankin量表(modified Rankin Scale,mRS)评分分为恢复良好组(mRS评分≤2分)和恢复不良组(mRS评分>2分)。分别采集患者的临床资料、相关生化指标、超声心动指标,并进行TOAST分型。肾功能评估采用慢性肾脏病流行病学合作工作组研究公式估算肾小球滤过率(estimated glomerular filtration rate,eGFR);左心室射血分数(left ventricular ejection fraction,LVEF)和舒张早期二尖瓣口血流速度峰值E峰/舒张晚期二尖瓣口血流速度峰值A峰(E/A)评估心功能。采用多因素Logistic回归分析及分层分析评估超声心动图参数和eGFR以及交互作用对脑卒中患者的影响。结果共纳入517例急性脑卒中患者(恢复良好组338例、恢复不良组179例),其中慢性肾脏病患病率为23.4%(121/517)。随着脑卒中患者eGFR分期的进展,恢复不良的比例显著增加(χ2=14.627,P=0.001)。恢复不良组患者LVEF和E/A均显著低于恢复良好组,而左心房收缩末期内径[(3.87±0.52) cm与(3.77±0.49) cm,t=-2.139,P=0.033],室间隔厚度[(1.10±0.19) cm与(1.04±0.16) cm,t=-4.056,P=0.000],左心室后壁厚度[(1.00±0.13) cm与(0.98±0.13) cm,t=-2.190,P=0.029],左心室心肌质量指数[(102.03±25.73)g/m2与(94.94±23.63)g/m2,t=-3.145,P=0.002]均显著高于恢复良好组,差异均有统计学意义。分层分析显示,在不同LVEF和E/A水平下,随着eGFR降低恢复不良率逐渐增加;无论与eGFR正常组及轻度下降组相比还是与LVEF高分位组相比,慢性肾病组均显著增加LVEF低分位组患者恢复不良率,而慢性肾病组在E/A各分位组间恢复不良率比较差异无统计学意义。不同卒中类型患者eGFR和LVEF水平差异均有统计学意义(F=7.433,P=0.000;F=2.617,P=0.034);与其他卒中类型相比,心源性栓塞型卒中(CE)Objective To investigate the effect of cardiac function and renal function on early neurological function recovery of acute stroke patients. Methods Hospitalized acute stroke patients from January 2010 to May 2018 were recruited in the Department of Neurology, Peking University First Hospital, who were divided into two groups according to the modified Rankin Scale (mRS) score at discharge, good recovery (mRS score ≤2) and poor recovery (mRS score >2). The clinical characteristics, laboratory and echocardiography data were collected respectively. All cases were classified according to Trial of Org 10 172 in Acute Stroke Treatment (TOAST) criteria. Estimated glomerular filtration rate (eGFR) was calculated by chronic kidney disease epidemiology collaboration equation in renal function assessment, and cardiac function was calculated by left ventricular ejection fraction (LVFF) and E-wave/A-wave ratio (E/A). Multivariate Logistic regression analysis and stratified analysis were performed to explore the effects of cardiac and renal function and interactions on stroke patients. Results A total of 517 patients with acute stroke were enrolled in this study, 23.4%(121/517) of which presented with chronic kidney disease. Poor recovery was aggravated with the progression of eGFR stage in patients with acute stroke (χ2=14.627, P=0.001). Compared with the good recovery group, LVEF and E/A were significantly lower in the poor recovery group, while left atrium diameter ((3.87±0.52) cm vs (3.77±0.49) cm, t=-2.139, P=0.033), interventricular septum thickness ((1.10±0.19) cm vs (1.04±0.16) cm, t=-4.056, P=0.000), left ventricular posterior wall thickness ((1.00±0.13) cm vs (0.98±0.13) cm, t=-2.190, P=0.029) and left ventricular mass index ((102.03±25.73) g/m2vs (94.94±23.63) g/m2, t=-3.145, P=0.002) were significantly higher in the poor recovery group. Stratified analysis showed that the rate of poor recovery increased with the decrease of eGFR at different levels of LVEF and E/A. Compared with patients of normal renal

关 键 词：卒中 慢性肾脏病 超声心动描记术 功能恢复 

分 类 号：R743.3[医药卫生—神经病学与精神病学]