急性腔隙性脑梗死患者的深部脑微出血与肾功能障碍

Deep Cerebral Microbleeds and Renal Dysfunction in Patients with Acute Lacunar Infarcts.

作者信息

Saji Naoki, Kimura Kazumi, Yagita Yoshiki, Uemura Junichi, Aoki Junya, Sato Takahiro, Sakurai Takashi

机构信息

Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Okayama, Japan; Center for Comprehensive Care and Research on Memory Disorders, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.

Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.

出版信息

J Stroke Cerebrovasc Dis. 2015 Nov;24(11):2572-9. doi: 10.1016/j.jstrokecerebrovasdis.2015.07.010. Epub 2015 Aug 29.

DOI:10.1016/j.jstrokecerebrovasdis.2015.07.010

PMID:26324515

Abstract

BACKGROUND

Cerebral small-vessel disease (SVD) is associated with renal dysfunction such as chronic kidney disease. Although cerebral microbleeds (CMBs) are common in patients with acute lacunar infarcts (ALI), the association between renal dysfunction and CMBs in such patients remains unclear.

METHODS

Between April 2007 and March 2013, we evaluated consecutive first-ever ALI patients, who were admitted to our hospital within 24 hours of stroke onset. CMBs were defined as focal areas of signal loss in brain parenchyma less than 5 mm on T2(∗)-weighted gradient-echo imaging. Renal dysfunction was defined as an estimated glomerular filtration rate less than 60 mL/minute/1.73 m(2) on admission. Correlations between renal dysfunction and the presence (model 1) and location of CMBs (model 2; any deep or infratentorial CMBs) were determined by multivariable logistic regression analyses.

RESULTS

Among 152 patients (33.6% men; mean age, 67.6 years), 53 had CMBs. Patients with CMBs were older (69.9 versus 66.3 years, P = .03) and had a higher frequency of white matter hyperintensity (WMH; 62.3% versus 25.3%, P < .001), silent lacunar infarcts (SLI; 75.5% versus 43.3%, P < .001), and renal dysfunction (41.5% versus 22.2%, P = .015) than those without CMBs. On multivariable analyses, renal dysfunction (odds ratio, 95% confidence interval; model 1: 2.38, 1.02-5.66; model 2: 2.78, 1.16-6.81), WMH (3.87, 1.76-8.80; 3.72, 1.64-8.71), SLI (3.85, 1.71-9.14; 4.20, 1.77-10.8), and diabetes mellitus (.26, .09-.63; .24, .08-.63) were independently associated with CMBs.

CONCLUSIONS

In patients with ALI, renal dysfunction was positively associated with CMBs independent of cerebral SVD.

摘要

背景

脑小血管病（SVD）与肾功能不全如慢性肾脏病相关。虽然脑微出血（CMB）在急性腔隙性脑梗死（ALI）患者中很常见，但此类患者中肾功能不全与CMB之间的关联仍不清楚。

方法

在2007年4月至2013年3月期间，我们评估了连续的首次发生ALI的患者，这些患者在卒中发作后24小时内入院。CMB被定义为在T2（*）加权梯度回波成像上脑实质内信号丢失的局灶性区域，直径小于5mm。肾功能不全被定义为入院时估计肾小球滤过率小于60mL/分钟/1.73m（2）。通过多变量逻辑回归分析确定肾功能不全与CMB的存在（模型1）和位置（模型2；任何深部或幕下CMB）之间的相关性。

结果

在152例患者（男性占33.6%；平均年龄67.6岁）中，53例有CMB。有CMB的患者年龄更大（69.9岁对66.3岁，P = 0.03），白质高信号（WMH）、无症状腔隙性脑梗死（SLI）和肾功能不全的发生率更高（WMH：62.3%对25.3%，P < 0.001；SLI：75.5%对43.3%，P < 0.001；肾功能不全：41.5%对22.2%，P = 0.015）。多变量分析显示，肾功能不全（比值比，95%置信区间；模型1：2.38，1.02 - 5.66；模型2：2.78，1.16 - 6.81）、WMH（3.87，1.76 - 8.80；3.72，1.64 - 8.71）、SLI（3.85，1.71 - 9.14；4.20，1.77 - 10.8）和糖尿病（0.26，0.09 - 0.63；0.24，0.08 - 0.63）与CMB独立相关。