Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
Eur J Neurol. 2014;21(1):160-6. doi: 10.1111/ene.12293. Epub 2013 Nov 15.
Atrial fibrillation (AF) can cause up to 50% of cardioembolic strokes and its effects may be exacerbated by chronic kidney disease. Our aim was to investigate the influence of reduced renal function on death, disability and stroke recurrence in stroke patients with AF in China.
In this prospective study, patients with ischaemic stroke and AF who were admitted within 1 month of stroke onset between January 2003 and February 2007 were consecutively enrolled. Patients were classified as having a reduced estimated glomerular filtration rate (eGFR) or normal eGFR, and clinical characteristics, functional outcomes and stroke recurrence were compared between the two groups.
A total of 229 patients were analyzed in the study, of whom 105 (45.9%) had reduced eGFR. These patients were more likely to be female, non-smokers and non-drinkers than were patients in the normal eGFR group (all P ≤ 0.002). Patients with reduced eGFR showed approximately 2-fold higher risk of death at 3, 6 and 12 months after stroke onset than did patients with normal eGFR (all P ≤ 0.042), after adjusting for age, sex and stroke severity on admission. However, the two groups showed similar 1-year cumulative stroke recurrence (P = 0.331, log rank test).
Reduced eGFR was independently associated with increased risk of death in patients with ischaemic stroke and AF. The association between reduced eGFR and risk of stroke recurrence needs to be explored in larger studies.
心房颤动（房颤）可导致多达 50%的心源性卒中，其影响可能因慢性肾脏病而加重。我们的目的是研究在中国房颤合并缺血性卒中患者中，肾功能降低对死亡、残疾和卒中复发的影响。
在这项前瞻性研究中，连续纳入了 2003 年 1 月至 2007 年 2 月发病 1 个月内的缺血性卒中和房颤患者。根据估算肾小球滤过率（eGFR）分为肾功能降低组和正常组，比较两组间的临床特征、功能结局和卒中复发情况。
共分析了 229 例患者，其中 105 例（45.9%）存在肾功能降低。与正常 eGFR 组相比，肾功能降低组患者更可能为女性、不吸烟者和不饮酒者（均 P ≤ 0.002）。在校正了年龄、性别和入院时的卒中严重程度后，肾功能降低组患者在卒中发病后 3、6 和 12 个月时的死亡风险约为正常 eGFR 组的 2 倍（均 P ≤ 0.042）。然而，两组患者的 1 年累积卒中复发率相似（P = 0.331，对数秩检验）。
在房颤合并缺血性卒中患者中，eGFR 降低与死亡风险增加独立相关。在更大的研究中需要进一步探讨 eGFR 降低与卒中复发风险之间的关系。
