Laible Mona, Horstmann Solveig, Möhlenbruch Markus, Wegele Christian, Rizos Timolaos, Schüler Svenja, Zorn Markus, Veltkamp Roland
Department of Neurology, University of Heidelberg, INF 400, 69120, Heidelberg, Germany.
Department of Neuroradiology, University of Heidelberg, Heidelberg, Germany.
J Neurol. 2015 Oct;262(10):2312-22. doi: 10.1007/s00415-015-7840-2. Epub 2015 Jul 15.
Kidney disease is a risk factor for cerebral microangiopathy and spontaneous intracerebral hemorrhage (ICH). We aimed to determine the association of renal dysfunction (RD) with MRI correlates of different patterns of cerebral microangiopathies including cerebral microbleeds (CMB) and white matter lesions (WML) in patients with ICH. In a prospectively collected, single-center cohort of ICH patients, glomerular filtration rate (eGFR) was estimated using the Modification of Diet in Renal Disease equation. We classified the renal function in five categories: category 1 (eGFR ≥ 90 mL/min/1.73 m(2)), category 2 (eGFR 60-89), category 3 (eGFR 30-59), category 4 (eGFR 15-29), and category 5 (eGFR <15) and dichotomized at an eGFR of 60. Number, location, and extent of CMB and WML were measured on MRI. ICH and CMB locations were classified as lobar or deep. 97 ICH patients with MRI (mean age 65.9 ± 13.9 years) were included. Intracerebral hemorrhage was lobar in 52.6 %. Median eGFR was 85.8 mL/min/1.73 m(2) (IQR 34.3). Renal dysfunction was present in 12.4 % of the patients. At least one CMB was present in 57.7 % of patients, WML were even more frequent (97.7 %). Age and impaired renal function were factors independently associated with the presence of CMB. The presence of CMB was independently associated with the number and extent of WML. RD is a frequent comorbidity in patients with ICH. Associations of RD with hypertension and with CMB in deep location suggest a predominant impact of RD on deep rather than on lobar microangiopathy.
肾脏疾病是脑微血管病变和自发性脑出血（ICH）的一个危险因素。我们旨在确定肾功能不全（RD）与不同类型脑微血管病变的MRI相关指标（包括脑微出血（CMB）和白质病变（WML））在ICH患者中的关联。在一个前瞻性收集的单中心ICH患者队列中，使用肾脏疾病饮食改良方程估算肾小球滤过率（eGFR）。我们将肾功能分为五类：1类（eGFR≥90 mL/ min/1.73 m²），2类（eGFR 60 - 89），3类（eGFR 30 - 59），4类（eGFR 15 - 29）和5类（eGFR <15），并以eGFR 60为界进行二分法分类。在MRI上测量CMB和WML的数量、位置和范围。ICH和CMB的位置分为叶型或深部型。纳入了97例有MRI检查结果的ICH患者（平均年龄65.9±13.9岁）。52.6%的脑出血为叶型。eGFR中位数为85.8 mL/ min/1.73 m²（四分位间距34.3）。12.4%的患者存在肾功能不全。57.7%的患者至少有一处CMB，WML更为常见（97.7%）。年龄和肾功能受损是与CMB存在独立相关的因素。CMB的存在与WML的数量和范围独立相关。RD是ICH患者中常见的合并症。RD与高血压以及深部CMB的关联表明，RD对深部而非叶型微血管病变有主要影响。
