Jung Jin-Man, Kim Hyun Jung, Ahn Hyeongsik, Ahn Il Min, Do Youngrok, Choi Jeong-Yoon, Seo Woo-Keun, Oh Kyungmi, Cho Kyung-Hee, Yu Sungwook
Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.
Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Republic of Korea.
J Neurol Sci. 2015 Nov 15;358(1-2):345-50. doi: 10.1016/j.jns.2015.09.353. Epub 2015 Sep 18.
The association between chronic kidney disease (CKD) and hemorrhagic complications or clinical outcomes in patients treated with intravenous (IV) thrombolytic agents is controversial.
We searched multiple databases for studies on the association between CKD and symptomatic intracerebral hemorrhage (ICH) and/or clinical outcomes in acute stroke patients treated with IV tissue plasminogen activator (tPA). Observational studies that evaluated the association between CKD and outcomes after adjusting for other confounding factors were eligible. We assessed study quality and performed a meta-analysis. The main outcome was symptomatic ICH. The secondary outcomes were poor functional status at 3 months using the modified Rankin Scale, mortality at 3 months, and any ICH.
Seven studies were selected based on our eligibility criteria. Of 7168 patients treated with IV tPA, 2001 (27.9%) had CKD. Patients with CKD had a higher risk of symptomatic ICH and mortality [pooled odds ratio (OR) 1.56, 95% confidence interval (CI) 1.05-2.33 and pooled OR 1.70, 95% CI 1.03-2.81, respectively]. Patients with CKD were likely to have an increased risk of poor outcome at 3 months. There was no significant association between CKD and any ICH.
Chronic kidney disease may significantly affect symptomatic hemorrhagic complications and poor clinical outcomes following administration of IV tPA.
慢性肾脏病（CKD）与接受静脉注射（IV）溶栓药物治疗的患者出血并发症或临床结局之间的关联存在争议。
我们在多个数据库中检索了关于CKD与接受IV组织型纤溶酶原激活剂（tPA）治疗的急性卒中患者症状性脑出血（ICH）和/或临床结局之间关联的研究。评估CKD与在调整其他混杂因素后的结局之间关联的观察性研究符合入选标准。我们评估了研究质量并进行了荟萃分析。主要结局是症状性ICH。次要结局是使用改良Rankin量表评估的3个月时功能状态差、3个月时死亡率以及任何类型的ICH。
根据我们的入选标准选择了7项研究。在7168例接受IV tPA治疗的患者中，2001例（27.9%）患有CKD。患有CKD的患者发生症状性ICH和死亡的风险更高[合并比值比（OR）分别为1.56，95%置信区间（CI）为1.05 - 2.33和合并OR为1.70，95% CI为1.03 - 2.81]。患有CKD的患者在3个月时出现不良结局的风险可能增加。CKD与任何类型的ICH之间无显著关联。
慢性肾脏病可能会显著影响IV tPA给药后的症状性出血并发症和不良临床结局。
