Department of Neurology, Tokai University School of Medicine, Kanagawa, Japan.
J Stroke Cerebrovasc Dis. 2012 Oct;21(7):547-50. doi: 10.1016/j.jstrokecerebrovasdis.2010.12.005. Epub 2011 Feb 4.
To examine the significance of renal dysfunction in patients who have sustained ischemic stroke, we examined the relationship between the renal function evaluated in terms of estimated glomerular filtration rate (eGFR) and the subtype of brain infarction (BI) in patients with ischemic stroke. A total of 639 patients with BI were enrolled in this study, with 314 subjects without stroke or transient ischemic attack registered as age-matched controls. eGFR was calculated according to the equation 194 × Cr(-1.094) × Age(-0.287) (-0.739 if female), where Cr is serum creatinine concentration, and was classified into four stages: stage I, eGFR ≥ 90 mL/min/1.73 m(2); stage II, eGFR 60 ~ 89 mL/min/1.73 m(2); stage III, eGFR 30 ~ 59 mL/min/1.73 m(2); and stage IV, eGFR <29 mL/min/1.73 m(2). Stage III-IV was significantly more prevalent in the BI group (38%) than in the control group (22%; P < .001). The odds ratio for stage III-IV was significantly higher in the BI group (1.93; 95% confidence interval [CI], 1.35-2.76). Among the BI subgroups, the odds ratios of stage III-IV for the atherothrombotic type (1.81; 95% CI, 1.23-2.68) and the cardiogenic type (2.25; 95% CI, 1.32-3.83) were significantly higher than that of the control group, but that of stage III-IV for lacunar type was not (1.67; 95% CI, 0.98-2.84). Our results indicate that ischemic stroke is frequently associated with renal dysfunction. Chronic kidney disease might be independent risk factor for infarction, especially for cardiogenic and atherosclerotic types.
为了探讨肾功能不全对缺血性脑卒中患者的意义，我们研究了脑梗死（BI）患者的肾小球滤过率（eGFR）与脑梗死亚型之间的关系。本研究共纳入 639 例 BI 患者，其中 314 例无卒中或短暂性脑缺血发作的患者作为年龄匹配的对照组。eGFR 根据方程 194×Cr(-1.094)×Age(-0.287)（女性为-0.739）计算，其中 Cr 为血清肌酐浓度，并分为四个阶段：I 期，eGFR≥90 mL/min/1.73 m(2)；II 期，eGFR 6089 mL/min/1.73 m(2)；III 期，eGFR 3059 mL/min/1.73 m(2)；IV 期，eGFR<29 mL/min/1.73 m(2)。BI 组中 III-IV 期明显多于对照组（38%比 22%；P<0.001）。BI 组 III-IV 期的比值比明显高于对照组（1.93；95%置信区间[CI]，1.35-2.76）。在 BI 亚组中，动脉粥样硬化型（1.81；95%CI，1.23-2.68）和心源性型（2.25；95%CI，1.32-3.83）的 III-IV 期比值比明显高于对照组，但腔隙型的 III-IV 期比值比不高（1.67；95%CI，0.98-2.84）。我们的结果表明，缺血性脑卒中常伴有肾功能不全。慢性肾脏病可能是梗死的独立危险因素，特别是心源性和动脉粥样硬化性梗死。
