老年高血压性脑出血患者慢性肾病与小血管病变的关系  

Relationship between chronic nephropathy and cerebral small vessel disease in elderly hypertensive cerebral hemorrhage patients

作　　者：李海燕[1] 沈光莉[1] 刘文宏[1] 张运[1] 戴缤[2] Li Haiyan;Shen Guangli;Liu Wenhong;Zhang Yun;Dai Bin(Department of Neurology,Affiliated Beijing Shijitan Hospital of Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院神经内科,100038 [2]首都医科大学附属北京世纪坛医院神经外科,100038

出　　处：《中华老年心脑血管病杂志》2019年第9期906-909,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：北京市科技计划(D141100000114001)

摘　　要：目的探讨老年高血压性脑出血患者慢性肾病与小血管病变的关系。方法选择2016年1月~2019年1月首都医科大学附属北京世纪坛医院神经内科和神经外科收治的老年高血压性脑出血患者162例,根据肾小球滤过率(GFR)水平分为观察组62例[GFR<90ml/(min 1.73m^2)]和对照组100例[GFR≥90ml/(min 1.73 m^2)]。比较2组小血管病变情况和其他临床特征。结果与对照组比较,观察组颈动脉内膜中层厚度、肌酐、美国国立卫生研究院卒中量表评分、收缩压和脑出血量明显增高,格拉斯哥昏迷评分明显降低,差异有统计学意义(P<0.01)。与对照组比较,观察组脑白质病变和血管周围间隙扩大比例明显增高[(83.9%vs48.0%,77.4%vs 42.0%,P=0.000]。多因素logistic回归分析显示,GFR<90ml/(min 1.73m^2)是老年高血压性脑出血患者脑白质病变和血管周围间隙扩大的危险因素(OR=1.523,95%CI:1.188~3.785,P=0.003;OR=1.652,95%CI:1.224~3.881,P=0.000)。结论老年高血压性脑出血患者慢性肾病是脑小血管病变的危险因素。Objective To study the relationship between chronic nephropathy and cerebral small vessel disease(CSVD)in elderly hypertensive cerebral hemorrhage patients.Methods One hundred and sixty-two elderly hypertensive cerebral hemorrhage patients admitted to our hospital were divided into observation group with its GFR<90 ml/min·1.73 m^2(n=62)and control group with its GFR≥90 ml/min·1.73 m2(n=100).The incidence and other clinical characteristics of CSVD were compared between the two groups.Results The IMT of carotid artery was significantly thicker,the serum creatinine level,NIHSS score and SBP were significantly higher,and the cerebral hemorrhage volume was significantly larger while the GCS score was significantly lower in observation group than in control group(P<0.01).The white matter lesion/enlarged perivascular space ratio was significantly higher in observation group than in control group(83.9%vs 48.0%,77.4%vs 42.0%,P=0.000).Multivariate logistic regression analysis showed that GFR<90 ml/min·1.73 m^2 was a risk factor for white matter lesions and enlarged perivascular space in elderly hypertensive cerebral hemorrhage patients(OR=1.523,95%CI:1.188-3.785,P=0.003;OR=1.652,95%CI:1.224-3.881,P=0.000).Conclusion Chronic nephropathy is a risk factor for CSVD in elderly hypertensive cerebral hemorrhage patients.

关 键 词：脑出血 肾病 大脑小血管疾病 肾小球滤过率 

分 类 号：R47[医药卫生—护理学]