Seliger Stephen L, Longstreth W T, Katz Ronit, Manolio Teri, Fried Linda F, Shlipak Michael, Stehman-Breen Catherine O, Newman Anne, Sarnak Mark, Gillen Daniel L, Bleyer Anthony, Siscovick David S
Division of Nephrology, University of Maryland, Baltimore, MD 21201, USA.
J Am Soc Nephrol. 2005 Dec;16(12):3721-7. doi: 10.1681/ASN.2005010006. Epub 2005 Oct 19.
Subclinical brain infarcts (SBI) are common in the elderly and are associated with covert neurologic and cognitive impairment. Although renal impairment is associated with accelerated cerebrovascular disease and an increased risk for clinically apparent brain infarct, few studies have examined the relationship between renal function and SBI, and these may have been limited by the inaccuracy of creatinine as a renal function marker. A cross-sectional study was performed among older adults in the Cardiovascular Health Study to examine associations between SBI and two serum markers of renal function: Serum creatinine (SCr) and cystatin C (CysC). Patients had cranial magnetic resonance imaging and renal markers measured in 1992 to 1993. Logistic regression was used to estimate the associations between renal function (estimated by 1/SCr and 1/CysC) and SBI, controlling for potential confounding factors. SBI were present in 789 (28.7%) of 2784 participants. A linear association with SBI was observed for 1/CysC (per 1-SD decrement; odds ratio [OR] 1.20; 95% confidence interval [CI] 1.09 to 1.32; P < 0.001) but not for 1/SCr (OR 1.08; 95% CI 0.98 to 1.19; P = 0.14), for which a quadratic U-shaped association was suggested (P = 0.004). In a model with both markers, 1/CysC was linearly associated with SBI (OR 1.26; P < 0.001), whereas 1/SCr was not (OR 1.06; P = 0.3). The prevalence of SBI was directly associated with quintile of CysC, whereas the association between SCr and SBI was U-shaped, with greater prevalence at high and low levels. Compared with creatinine, CysC, a novel marker of renal function, has a stronger and more direct association with SBI in the elderly.
亚临床脑梗死（SBI）在老年人中很常见，且与隐匿性神经和认知功能损害相关。虽然肾功能损害与脑血管疾病加速及临床明显脑梗死风险增加有关，但很少有研究探讨肾功能与SBI之间的关系，而且这些研究可能受到肌酐作为肾功能标志物不准确的限制。在心血管健康研究中对老年人进行了一项横断面研究，以检验SBI与两种肾功能血清标志物：血清肌酐（SCr）和胱抑素C（CysC）之间的关联。患者于1992年至1993年进行了头颅磁共振成像检查并测量了肾脏标志物。采用逻辑回归来估计肾功能（通过1/SCr和1/CysC估算）与SBI之间的关联，并控制潜在的混杂因素。2784名参与者中有789名（28.7%）存在SBI。观察到1/CysC与SBI呈线性关联（每降低1个标准差；比值比[OR]为1.20；95%置信区间[CI]为1.09至1.32；P<0.001），而1/SCr则不然（OR为1.08；95%CI为0.98至1.19；P = 0.14），提示1/SCr存在二次U形关联（P = 0.004）。在包含两种标志物的模型中，1/CysC与SBI呈线性关联（OR为1.26；P<0.001），而1/SCr则无此关联（OR为1.06；P = 0.3）。SBI的患病率与CysC的五分位数直接相关，而SCr与SBI之间的关联呈U形，在高水平和低水平时患病率更高。与肌酐相比，作为一种新型肾功能标志物的CysC在老年人中与SBI的关联更强且更直接。
