Kobayashi Shuzo, Ikeda Toshio, Moriya Hidekazu, Ohtake Takayasu, Kumagai Hiromichi
Department of Nephrology and Kidney and Dialysis Center, Shonan Kamakura General Hospital, Kamakura, Japan.
Am J Kidney Dis. 2004 Jul;44(1):35-41. doi: 10.1053/j.ajkd.2004.03.026.
It remains unknown whether the prevalence of silent lacunar infarcts increases as renal function declines or what factors known as atherosclerotic risk factors are related to the development of lacunar infarcts.
Fifty-one patients with chronic kidney disease without diabetes mellitus and 80 patients with essential hypertension with normal renal function were included in the study. The existence of lacunar infarcts was evaluated on brain magnetic resonance imaging scans. We evaluated the severity of carotid atherosclerosis by means of intima-media thickness of 1.0 mm or greater height in bilateral carotid arteries and by affecting factors, including plasma homocysteine levels.
Lacunae prevalence was 25% in patients with a creatinine clearance (Ccr) greater than 40 mL/min/1.73 m2, 85% in patients with a Ccr less than 40 mL/min/1.73 m2, and 29% in patients with essential hypertension with normal renal function. Patients with lacunae had significantly lower hematocrits associated with increased fibrinogen and lipoprotein(a) levels compared with those without lacunae. Plasma total homocysteine and insulin levels at 2 hours after a 75-g glucose tolerance test correlated significantly with lacunae. Ischemic heart changes shown by electrocardiogram and thickened carotid intima-media thickness were significantly more frequent in patients with lacunae. However, logistic regression analysis showed that the most strongly contributing factor for lacunar infarcts was decline in Ccr (confidence interval, 0.933 to 0.995; P < 0.05).
Decreased renal function, even without diabetes mellitus, is a risk factor for silent lacunar infarcts.
尚不清楚无症状腔隙性脑梗死的患病率是否会随着肾功能下降而增加，也不清楚哪些已知的动脉粥样硬化危险因素与腔隙性脑梗死的发生有关。
本研究纳入了51例无糖尿病的慢性肾脏病患者和80例肾功能正常的原发性高血压患者。通过脑部磁共振成像扫描评估腔隙性脑梗死的存在情况。我们通过双侧颈动脉内膜中层厚度≥1.0 mm以及包括血浆同型半胱氨酸水平在内的影响因素来评估颈动脉粥样硬化的严重程度。
肌酐清除率（Ccr）大于40 mL/min/1.73 m²的患者中腔隙性脑梗死患病率为25%，Ccr小于40 mL/min/1.73 m²的患者中患病率为85%，肾功能正常的原发性高血压患者中患病率为29%。与无腔隙性脑梗死的患者相比，有腔隙性脑梗死的患者血细胞比容显著降低，同时纤维蛋白原和脂蛋白（a）水平升高。75克葡萄糖耐量试验后2小时的血浆总同型半胱氨酸和胰岛素水平与腔隙性脑梗死显著相关。有腔隙性脑梗死的患者心电图显示的缺血性心脏改变以及颈动脉内膜中层增厚明显更常见。然而，逻辑回归分析显示，对腔隙性脑梗死影响最大的因素是Ccr下降（置信区间为0.933至0.995；P<0.05）。
即使没有糖尿病，肾功能下降也是无症状腔隙性脑梗死的一个危险因素。
