Department of Neurology, Chubu Rosai Hospital, Nagoya, Japan.
Am J Hypertens. 2012 Apr;25(4):430-6. doi: 10.1038/ajh.2011.254. Epub 2012 Jan 12.
Brain microbleeds (BMBs) detected on gradient echo T2*-weighted magnetic resonance imaging (GE-MRI) may be pathophysiologically linked to ischemic cerebral small-vessel disease (SVD) and increased risk of future hemorrhagic stroke. Chronic kidney disease (CKD) has been associated with the presence of BMBs in stroke patients. However, the relationship between CKD markers and BMBs in stroke-free populations is unknown.
Two hundred and eighty-five hypertensive subjects (mean age 68.6 years) without neurological symptoms were enrolled from a hospital-based outpatient clinic and all participants underwent GE-MRI. We calculated urinary albumin/creatinine ratio (UACR) from morning spot urine and the estimated glomerular filtration rate (eGFR) in serum samples. Multivariate logistic regression analysis was used to evaluate the association between these kidney biomarkers and the presence and location of BMBs, controlling for age, sex, use of antihypertensive or antithrombotic drugs, and MRI findings.
BMBs were observed in 48 (16.8%) patients. Median UACRs were significantly higher in patients with deep or infratentorial BMBs than in patients with pure lobar BMBs (54 vs. 17 mg/g creatinine, P = 0.04). No significant differences were found between eGFR levels and the location of BMBs. Microalbuminuria (UACR >30- ≤300 mg/g creatinine), but not low eGFR level was significantly associated with higher prevalence of deep or infratentorial BMBs (odds ratio (OR): 3.16, 95% confidence interval (CI): 1.34-7.44, P = 0.009) even after adjustment for potential confounding factors.
Microalbuminuria is closely associated with the prevalence of deep or infratentorial BMBs in hypertensive patients. Our findings provide new insights into the association between risk factors and the distribution of BMBs.
梯度回波 T2*-加权磁共振成像（GE-MRI）检测到的脑微出血（BMB）可能与缺血性脑小血管病（SVD）和未来出血性中风风险增加在病理生理学上相关。慢性肾脏病（CKD）与中风患者 BMB 的存在有关。然而，在无中风的人群中，CKD 标志物与 BMB 之间的关系尚不清楚。
我们从医院门诊招募了 285 名无神经系统症状的高血压患者（平均年龄 68.6 岁），并对所有参与者进行了 GE-MRI 检查。我们从早晨的尿液样本中计算尿白蛋白/肌酐比值（UACR），并从血清样本中计算肾小球滤过率估计值（eGFR）。使用多变量逻辑回归分析来评估这些肾脏生物标志物与 BMB 的存在和位置之间的关系，同时控制年龄、性别、使用抗高血压或抗血栓药物以及 MRI 发现。
在 48 名（16.8%）患者中观察到 BMB。与纯皮质下 BMB 患者相比，有深部或幕下 BMB 患者的 UACR 中位数明显更高（54 与 17 mg/g 肌酐，P = 0.04）。eGFR 水平与 BMB 的位置之间无显著差异。微量白蛋白尿（UACR >30-≤300 mg/g 肌酐），而不是低 eGFR 水平，与深部或幕下 BMB 的更高发生率显著相关（比值比（OR）：3.16，95%置信区间（CI）：1.34-7.44，P = 0.009），即使在调整了潜在混杂因素后也是如此。
微量白蛋白尿与高血压患者深部或幕下 BMB 的发生率密切相关。我们的发现为危险因素与 BMB 分布之间的关系提供了新的见解。
