Hsieh Cheng-Yang, Lin Huey-Juan, Sung Sheng-Feng, Yang Yea-Huei Kao, Lai Edward Chia-Cheng, Hsieh Han-Chieh, Chen Chih-Hung
Institute of Clinical Pharmacy and Pharmaceutical Science, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Neurology, Tainan Sin Lau Hospital, Tainan, Taiwan.
Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan; Department of Cosmetic Science, Chia Nan University of Pharmacy & Science, Tainan, Taiwan.
J Stroke Cerebrovasc Dis. 2015 Mar;24(3):673-9. doi: 10.1016/j.jstrokecerebrovasdis.2014.11.006. Epub 2015 Jan 7.
About one third of stroke patients have renal dysfunction. Effect of renal dysfunction on outcome of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) has not been determined in Asia using patients without IVT as comparators. The aim of this study was to examine the interaction between renal dysfunction and IVT on the outcomes in AIS patients admitted within 4.5 hours of onset in a multicenter stroke registry of Taiwan.
We identified all consecutive AIS patients admitted within 4.5 hours of onset between 2007 and 2013. Renal dysfunction was defined by an estimated glomerular filtration rate less than 60 mL/minute/1.73 m(2) on initial admission. Patients older than 80 years of age and a National Institute of Health Stroke Scale score less than 4 or greater than 25 were excluded. The primary outcome was a modified Rankin Scale score 3-6 at 3 months. We determined the effect of IVT and renal dysfunction on outcome in a multivariate analysis.
Of the 929 patients analyzed, 39% had renal dysfunction, and 51% received IVT. Primary outcomes occurred in 45% versus 41% of patients with and without renal dysfunction, respectively, (P = .197). In a multivariate analysis, the odds ratios (95% confidence interval; P value) of IVT and renal dysfunction for primary outcome were .70 (.51-.96; P = .029) and .97 (.71-1.33; P = .865), respectively. No significant interaction was noted between IVT and renal dysfunction (P = .218).
Renal dysfunction did not modify the effect of IVT for AIS and should not be a reason for withholding treatment from otherwise-eligible patients.
约三分之一的中风患者存在肾功能不全。在亚洲，以未接受静脉溶栓治疗（IVT）的患者作为对照，肾功能不全对急性缺血性中风（AIS）静脉溶栓治疗结局的影响尚未明确。本研究旨在探讨在台湾多中心中风登记处中，发病4.5小时内入院的AIS患者中，肾功能不全与IVT对结局的相互作用。
我们确定了2007年至2013年期间发病4.5小时内入院的所有连续性AIS患者。肾功能不全定义为初次入院时估计肾小球滤过率低于60 mL/分钟/1.73 m²。排除年龄大于80岁、美国国立卫生研究院卒中量表评分低于4或高于25的患者。主要结局是3个月时改良Rankin量表评分为3 - 6分。我们在多变量分析中确定了IVT和肾功能不全对结局的影响。
在分析的929例患者中，39%存在肾功能不全，51%接受了IVT。有和没有肾功能不全的患者主要结局发生率分别为45%和41%（P = 0.197）。在多变量分析中，IVT和肾功能不全对主要结局的比值比（95%置信区间；P值）分别为0.70（0.51 - 0.96；P = 0.029）和0.97（0.71 - 1.33；P = 0.865）。IVT和肾功能不全之间未发现显著相互作用（P = 0.218）。
肾功能不全并未改变IVT对AIS的治疗效果，不应成为拒绝为其他符合条件的患者进行治疗的理由。
