Stroke Center, Department of Neurology and Sagol Neuroscience Center, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Cerebrovasc Dis. 2011;31(3):271-7. doi: 10.1159/000322155. Epub 2010 Dec 21.
Chronic kidney disease (CKD) is associated with both a risk of adverse vascular outcome and a risk of bleeding. We have tested the hypothesis that in the setting of an acute intracerebral hemorrhage (ICH), CKD is associated with poor outcome and with larger hematoma volume.
We examined the association between CKD and ICH characteristics and outcome within a prospective cohort study of consecutive patients hospitalized with an acute stroke and followed for 1 year. CKD was categorized by the estimated baseline glomerular filtration rate into moderate/severe impairment (<45), mild impairment (45-60) and no impairment (>60 ml/min/1.73 m(2)).
Among 128 patients with an ICH (mean age = 71.7 ± 12.3 years, 41.4% women) 46.1% had CKD (23.4% mild and 22.7% moderate/severe). Patients with moderate/severe impairment had >4-fold adjusted hazard ratio for mortality over 1 year (4.29; 95% CI = 1.69-10.90) compared to patients with no impairment. The hematoma volumes [median (25-75%)] were 15.3 ml (5.4-37.5) in patients with no impairment, 16.6 (6.8-36.9) in mild impairment and 50.2 (10.4-109.1) in moderate/severe impairment (p = 0.009). The location of the hematoma was lobar in 12% with no impairment, 17% with mild impairment and 39% with moderate/severe impairment (p = 0.02). Patients with moderate/severe impairment exhibited a 2.3-fold higher hematoma volume (p = 0.04) and a >6-fold higher odds of lobar location (95% CI = 1.59-24.02) as compared to no impairment. Further adjustment for antiplatelet use and for presence of leukoaraiosis attenuated the association with hematoma volume (p = 0.15), while moderate/severe impairment was associated with an adjusted OR of 5.35 (95% CI = 1.18-24.14) for lobar location.
Presence of moderate/severe CKD among patients with ICH is associated with larger, lobar hematomas and with poor outcome.
慢性肾脏病（CKD）与不良血管预后风险和出血风险都相关。我们曾提出假说，在急性脑出血（ICH）情况下，CKD 与不良结局和更大的血肿体积相关。
我们在一项连续纳入因急性脑卒中住院且随访 1 年的患者的前瞻性队列研究中，检验了 CKD 与 ICH 特征和结局之间的关联。通过估算的基线肾小球滤过率，将 CKD 分为中重度损害（<45）、轻度损害（45-60）和无损害（>60ml/min/1.73m2）。
在 128 例 ICH 患者中（平均年龄 71.7±12.3 岁，41.4%为女性），46.1%患有 CKD（23.4%为轻度，22.7%为中重度）。与无损害相比，中重度损害患者的 1 年死亡率调整后危险比（HR）>4 倍（4.29；95%CI=1.69-10.90）。无损害、轻度损害和中重度损害患者的血肿体积[中位数（25-75%）]分别为 15.3ml（5.4-37.5）、16.6ml（6.8-36.9）和 50.2ml（10.4-109.1）（p=0.009）。无损害患者的血肿部位为叶性者占 12%，轻度损害者占 17%，中重度损害者占 39%（p=0.02）。与无损害相比，中重度损害患者的血肿体积高出 2.3 倍（p=0.04），叶性血肿的几率高出 6 倍（95%CI=1.59-24.02）。进一步调整抗血小板药物的使用和存在脑白质疏松症后，血肿体积的关联减弱（p=0.15），而中重度损害与叶性血肿的调整后比值比（OR）为 5.35（95%CI=1.18-24.14）。
ICH 患者中存在中重度 CKD 与更大的、叶性血肿和不良结局相关。
