Oh Mi-Young, Lee Hyon, Kim Joon Soon, Ryu Wi-Sun, Lee Seung-Hoon, Ko Sang-Bae, Kim Chulho, Kim Chang Hun, Yoon Byung-Woo
Department of Neurology, Seoul National University Hospital, 101 Daehang-ro, Jongno-gu, Seoul, Republic of Korea.
BMC Neurol. 2014 Jun 12;14:127. doi: 10.1186/1471-2377-14-127.
Chronic renal insufficiency, diagnosed using creatinine based estimated glomerular filtration rate (GFR) or microalbumiuria, has been associated with the presence of cerebral microbleeds (CMBs). Cystatin C has been shown to be a more sensitive renal indicator than conventional renal markers. Under the assumption that similar pathologic mechanisms of the small vessel exist in the brain and kidney, we hypothesized that the levels of cystatin C may delineate the relationship between CMBs and renal insufficiency by detecting subclinical kidney dysfunction, which may be underestimated by other indicators, and thus reflect the severity of CMBs more accurately.
Data was prospectively collected for 683 patients with ischemic stroke. The severity of CMBs was categorized by the number of lesions. Patients were divided into quartiles of cystatin C, estimated GFR and microalbumin/creatinine ratios. Ordinal logistic regression analysis was used to examine the association of each renal indicator with CMBs.
In models including both quartiles of cystatin C and estimated GFR, only cystatin C quartiles were significant (the highest vs. the lowest, adjusted OR, 1.88; 95% CI 1.05-3.38; p = 0.03) in contrast to estimated GFR (the highest vs. the lowest, adjusted OR, 1.28; 95% CI 0.38-4.36; p = 0.70). A model including both quartiles of cystatin C and microalbumin/creatinine ratio also showed that only cystatin C quartiles was associated with CMBs (the highest vs. the lowest, adjusted OR, 2.06; 95% CI 1.07-3.94; p = 0.03). These associations were also observed in the logistic models using log transformed-cystatin C, albumin/creatinine ratio and estimated GFR as continuous variables. Cystatin C was a significant indicator of deep or infratenorial CMBs, but not strictly lobar CMBs. In addition, cystatin C showed the greatest significance in c-statistics for the presence of CMBs (AUC = 0.73 ± 0.03; 95% CI 0.66-0.76; p = 0.02).
Cystatin C may be the most sensitive indicator of CMB severity among the renal disease markers.
使用基于肌酐的估计肾小球滤过率（GFR）或微量白蛋白尿诊断的慢性肾功能不全与脑微出血（CMB）的存在有关。胱抑素C已被证明是一种比传统肾脏标志物更敏感的肾脏指标。基于脑和肾脏存在相似的小血管病理机制这一假设，我们推测胱抑素C水平可能通过检测其他指标可能低估的亚临床肾功能不全来描绘CMB与肾功能不全之间的关系，从而更准确地反映CMB的严重程度。
前瞻性收集683例缺血性中风患者的数据。根据病变数量对CMB的严重程度进行分类。患者被分为胱抑素C、估计GFR和微量白蛋白/肌酐比值的四分位数。使用有序逻辑回归分析来检验每个肾脏指标与CMB的关联。
在包括胱抑素C四分位数和估计GFR的模型中，与估计GFR（最高四分位数与最低四分位数相比，调整后的OR为1.28；95%CI为0.38 - 4.36；p = 0.70）相比，只有胱抑素C四分位数具有显著性（最高四分位数与最低四分位数相比，调整后的OR为1.88；95%CI为1.05 - 3.38；p = 0.03）。包括胱抑素C四分位数和微量白蛋白/肌酐比值的模型也显示只有胱抑素C四分位数与CMB相关（最高四分位数与最低四分位数相比，调整后的OR为2.06；95%CI为1.07 - 3.94；p = 0.03）。在使用对数转换后的胱抑素C、白蛋白/肌酐比值和估计GFR作为连续变量的逻辑模型中也观察到了这些关联。胱抑素C是深部或幕下CMB的显著指标，但对严格的脑叶CMB不是显著指标。此外，胱抑素C在CMB存在的c统计量中显示出最大的显著性（AUC = 0.73 ± 0.03；95%CI为0.66 - 0.76；p = 0.02）。
在肾脏疾病标志物中，胱抑素C可能是CMB严重程度最敏感的指标。
