van Overbeek Ellen C, Staals Julie, van Oostenbrugge Robert J
Department of Neurology, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands
Department of Neurology, Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands Cardiovascular Research Institute Maastricht, MUMC, Maastricht, the Netherlands.
Int J Stroke. 2016 Aug;11(6):695-700. doi: 10.1177/1747493016641966. Epub 2016 Mar 25.
It is hypothesized that impaired kidney function and cerebral microbleeds represent microvascular damage in different organs. Several cross-sectional studies found impaired kidney function to be associated with the presence of cerebral microbleeds.
To further confirm the association between both small vessel diseases, we aimed to determine whether kidney function is related to progression of cerebral microbleeds in a longitudinal study design.
In 89 lacunar stroke patients, baseline brain magnetic resonance imaging (including gradient-echo images), baseline estimated glomerular filtration rate (eGFR), blood pressure measurements, and follow-up brain magnetic resonance imaging after two years were available. Presence of cerebral microbleeds on baseline and follow-up magnetic resonance imaging was scored visually. Cerebral microbleeds progression was defined as the presence of any new microbleed on follow-up magnetic resonance imaging. The association between cerebral microbleeds progression (dependent variable) and eGFR (independent variable) was assessed by logistic regression analysis.
Cerebral microbleeds progression was present in 17 patients (19.1%). Lower eGFR was associated with cerebral microbleeds progression (OR 1.55 per 10 ml/min/1.73 m(2) decrease, 95% CI 1.05-2.30, with correction for sex and age). After additional correction for baseline presence of cerebral microbleeds or correction for cardiovascular risk factors, including blood pressure, this result remained significant.
In this longitudinal study, we found an independent association between lower eGFR and cerebral microbleeds progression. Cerebral microbleeds and impaired kidney function are both seen as manifestations of microvascular organ damage and our findings further strengthen the association between both small vessel pathologies and also the assumption that small vessel disease could be considered a multisystem disorder.
据推测，肾功能受损和脑微出血代表不同器官的微血管损伤。多项横断面研究发现肾功能受损与脑微出血的存在有关。
为了进一步证实这两种小血管疾病之间的关联，我们旨在通过纵向研究设计确定肾功能是否与脑微出血的进展有关。
在89例腔隙性卒中患者中，可获得基线脑磁共振成像（包括梯度回波图像）、基线估计肾小球滤过率（eGFR）、血压测量值以及两年后的随访脑磁共振成像。通过视觉对基线和随访磁共振成像上的脑微出血情况进行评分。脑微出血进展定义为随访磁共振成像上出现任何新的微出血。通过逻辑回归分析评估脑微出血进展（因变量）与eGFR（自变量）之间的关联。
17例患者（19.1%）出现脑微出血进展。较低的eGFR与脑微出血进展相关（每降低10 ml/min/1.73 m²，比值比为1.55，95%可信区间为1.05 - 2.30，校正性别和年龄后）。在对脑微出血的基线存在情况进行额外校正或对包括血压在内的心血管危险因素进行校正后，该结果仍然显著。
在这项纵向研究中，我们发现较低的eGFR与脑微出血进展之间存在独立关联。脑微出血和肾功能受损均被视为微血管器官损伤的表现，我们的研究结果进一步强化了这两种小血管病变之间的关联，也强化了小血管疾病可被视为多系统疾病的假设。
