Jeon Jae Woong, Jeong Hye Seon, Choi Dae Eun, Ham Young Rok, Na Ki Ryang, Lee Kang Wook, Shin Jong Wook, Kim Jei
Division of Nephrology, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
Department of Neurology, College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
J Stroke Cerebrovasc Dis. 2017 Feb;26(2):385-392. doi: 10.1016/j.jstrokecerebrovasdis.2016.09.037. Epub 2016 Oct 25.
It is well known that renal dysfunction and cerebral small-vessel disease (SVD), including microbleed, lacunar infarction, and white matter lesion (WML), are associated with poor prognosis after ischemic stroke. However, the prognostic relationship between renal dysfunction and SVD has not been well evaluated in acute ischemic stroke survivors. Therefore, in this study, we evaluated the prognostic relationships between estimated glomerular filtration rate (eGFR) and cerebral SVD after acute ischemic stroke.
We retrospectively reviewed the clinical and radiological data of acute ischemic stroke survivors with decreased eGFR (<60 mL/min/1.73 m, n = 128) and controls (eGFR ≥60 mL/min/1.73 m, n = 128). The presence of SVD was evaluated according to magnetic resonance imaging performed on admission. Mortality data were obtained from medical chart reviews and telephone interviews.
Patients with silent lacunar infarction, WML, or microbleed had lower eGFR than patients without such lesions (60.4 ± 34.8 versus 87.5 ± 28.4 mL/min/1.73 m, 60.5 ± 37.1 versus 73.9 ± 33.3 mL/min/1.73 m, and 57.6 ± 33.3 versus 73.9 ± 32.9 mL/min/1.73 m, respectively). In addition, the multivariate adjusted odds ratio for the presence of SVD increased inversely with eGFR. Three-year survival was lower in patients with renal dysfunction and each type of SVD. The presence of WML was an independent risk factor for cardiovascular death.
Renal impairment was associated with the presence of SVD in acute ischemic stroke survivors. Both renal impairment and the presence of SVD were predictors of poor poststroke survival.
众所周知，肾功能不全与脑小血管疾病（SVD），包括微出血、腔隙性梗死和白质病变（WML），与缺血性中风后的不良预后相关。然而，急性缺血性中风幸存者中肾功能不全与SVD之间的预后关系尚未得到充分评估。因此，在本研究中，我们评估了急性缺血性中风后估计肾小球滤过率（eGFR）与脑SVD之间的预后关系。
我们回顾性分析了eGFR降低（<60 mL/min/1.73 m²，n = 128）的急性缺血性中风幸存者和对照组（eGFR≥60 mL/min/1.73 m²，n = 128）的临床和影像学数据。根据入院时进行的磁共振成像评估SVD的存在情况。通过病历审查和电话访谈获得死亡率数据。
无症状腔隙性梗死、WML或微出血的患者eGFR低于无此类病变的患者（分别为60.4±34.8与87.5±28.4 mL/min/1.73 m²，60.5±37.1与73.9±33.3 mL/min/1.73 m²，以及57.6±33.3与73.9±32.9 mL/min/1.73 m²）。此外，SVD存在的多变量调整比值比与eGFR呈负相关。肾功能不全和每种类型SVD的患者三年生存率较低。WML的存在是心血管死亡的独立危险因素。
肾功能损害与急性缺血性中风幸存者中SVD的存在相关。肾功能损害和SVD的存在都是中风后生存不良的预测因素。
