急性腔隙性脑梗死脑微出血进展的危险因素及与肾功能的关系研究  

Risk factors for cerebral microhemorrhage progression in acute lacunar cerebral infarction and its relationship with renal function

作　　者：侯晓莉 李舟 HOU Xiao-li;LI Zhou(Department of Neurology,General Hospital of Pingmei Shenma Medical Group,Pingdingshan,Henan 467000,China)

机构地区：[1]平煤神马医疗集团总医院神经内科,河南省平顶山市467000

出　　处：《医药论坛杂志》2025年第2期138-142,共5页Journal of Medical Forum

摘　　要：目的 探讨急性腔隙性脑梗死脑微出血进展发生危险因素及相关危险因素预测效能,并进一步评估脑微出血进展与肾功能的关系,旨在为临床防治工作提供借鉴。方法 回顾性纳入2023年6月—2024年5月于平煤神马医疗集团总医院诊治急性腔隙性脑梗死278例,根据发病后随访12个月有无脑微出血进展分组;比较进展组和无进展组临床特征资料,采用多因素法评估患者脑微出血进展发生危险因素并进一步评估肾功能相关指标用于脑微出血进展发生风险预测临床效能。结果 本研究纳入278例患者发病后随访12个月发生脑微出血进展共50例,发生率为17.99%。进展组年龄和入院24 h内平均动脉压均大于无进展组,差异有统计学意义(P<0.05);进展组血管紧张素Ⅱ受体拮抗剂/血管紧张素转化酶抑制剂(angiotensinⅡreceptor blocker/angiotensin-converting enzyme inhibitor,ARB/ACEI)类药物使用比例和入院时估算肾小球滤过率(estimated glomerular filtration rate,eGFR)水平均低于无进展组,差异有统计学意义(P<0.05)。多因素分析结果显示,入院时更低eGFR水平和未使用ARB/ACEI类药物均是急性腔隙性脑梗死脑微出血进展发生独立危险因素(P<0.05)。受试者工作特征(receiver operating characteristic,ROC)曲线分析结果显示,ARB/ACEI类药物使用情况、入院时eGFR水平及两者联合均可用于脑微出血进展发生风险预测,曲线下面积分别为0.77,0.84,0.92。结论 入院时eGFR水平较低或未使用ARB/ACEI类药物使用的急性腔隙性脑梗死患者脑微出血进展发生风险更高,提示基线肾功能不佳及未行积极有效肾功能保护可能诱发患者脑微出血进展发生。Objective To investigate the risk factors and prediction efficiency for cerebral microhemorrhage progression in acute lacunar cerebral infarction and further evaluate the relationship between cerebral microhemorrhage and renal function to provide reference for clinical prevention and treatment work.Methods Totally 278 cases with acute lacunar cerebral infarction diagnosed and treated in the General Hospital of Pingmei Shenma Medical Group from June 2023 to May 2024 were retrospectively included and grouped according to whether there was cerebral microhemorrhage during 12 months of follow-up.The clinical characteristics of progression group and non-progression group were compared,and the risk factors of cerebral microhemorrhage progression were evaluated by polyfactor method,and the clinical efficacy of renal function indicators in predicting of cerebral microhemorrhage progression risk was further evaluated.Results There were 50 cases with cerebral microhemorrhage progression during 12 months of follow-up in all 278 patients accounting for 17.99%.The age and mean arterial pressure within 24 h of admission in progression group were higher than those in non-progression group,and the difference were statistically significant(P<0.05).The proportion of angiotensinⅡreceptor blocker/angiotensin-converting enzyme inhibitor(ARB/ACEI) drug used and estimated glomerular filtration rate(eGFR) level at admission in progression group were lower than those in non-progression group,and the difference were statistically significant(P<0.05).Multivariate analysis showed that decreased eGFR level and no used of ARB/ACEI drugs at admission were the independent risk factors for the progression of cerebral microhemorrhage in patients with acute lacunar infarction(P<0.05).Receiver operating characteristic(ROC) curve analysis results showed that eGFR level,ARB/ACEI drug use and their combination could be used to predict the cerebral microhemorrhage progression risk,and the area under the curve of above three were 0.77,0.84,0.92,respect

关 键 词：急性腔隙性脑梗死 脑微出血 肾功能 危险因素 

分 类 号：R743.3[医药卫生—神经病学与精神病学]