估算肾小球滤过率与伴有重度颈动脉狭窄的缺血性脑卒中患者临床结局的相关性。
Association between estimated glomerular filtration rate and clinical outcomes in ischemic stroke patients with high-grade carotid artery stenosis.
机构信息
Department of Neurology, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital, Keelung branch, No.222, Mai-Jin Road, Keelung, 204, Taiwan.
出版信息
BMC Neurol. 2021 Mar 19;21(1):124. doi: 10.1186/s12883-021-02154-3.
BACKGROUND
Chronic kidney disease has been identified as a risk factor affecting stroke prognosis. High-grade carotid artery stenosis (CAS) is associated with distal hemodynamic compromise. The association between the estimated glomerular filtration rate (eGFR) and ischemic stroke (IS) outcome in patients with high-grade CAS remains unclear. We aimed to investigate the association between eGFR and outcomes of acute IS patients with high-grade CAS.
METHODS
From January 1, 2007 to April 30, 2012, we enrolled 372 acute IS patients with high-grade CAS and prospectively observed them for 5 years. The eGFR on admission was assessed using the Modification of Diet in Renal Disease Study equation. Demographic features, vascular risk factors, comorbidities, and outcomes were compared between different eGFR levels.
RESULTS
Among 372 individuals, 76 (20.4%) had an eGFR < 45, 65 (17.5%) had an eGFR between 45 and 59, and 231 (62.1%) had an eGFR ≥60 mL/min/1.73 m. Compared to other groups, in the eGFR < 45 mL/min/1.73 m group, the prevalence rates of hypertension, diabetes mellitus, coronary artery disease, congestive heart failure, valvular heart disease, and gout were significantly higher (P = 0.013, P = 0.030, P = 0.001, P < 0.001, P = 0.043, and P < 0.001, respectively). Patients with eGFR < 45 mL/min/1.73 m demonstrated lower hemoglobin and total cholesterol levels compared with other groups (P < 0.001 and P = 0.048). The blood potassium and uric acid levels were significantly higher in patients with eGFR < 45 mL/min/1.73 m (P < 0.001 and P < 0.001). The multivariate Cox proportional hazards model indicated that eGFR < 45 mL/min/1.73 m was a significant risk factor for 5-year all-cause mortality in IS patients with high-grade CAS after adjusting for these variables (hazard ratio = 2.05; 95% CI = 1.31-3.21; P = 0.002).
CONCLUSIONS
eGFR < 45 mL/min/1.73 m was associated with an increased risk of 5-year all-cause mortality in acute IS patients with high-grade CAS. Whether aggressive treatment of chronic kidney disease in IS patients with high-grade CAS can improve stroke outcomes should be confirmed in future studies.
背景
慢性肾脏病已被确定为影响中风预后的危险因素。颈动脉狭窄程度高（CAS）与远端血液动力学受损有关。高分级 CAS 患者的估计肾小球滤过率（eGFR）与缺血性中风（IS）结局之间的关系尚不清楚。我们旨在探讨高分级 CAS 急性 IS 患者的 eGFR 与结局之间的关系。
方法
2007 年 1 月 1 日至 2012 年 4 月 30 日，我们纳入了 372 例高分级 CAS 的急性 IS 患者，并前瞻性观察了他们 5 年。入院时使用肾脏病饮食改良研究方程评估 eGFR。比较不同 eGFR 水平的人口统计学特征、血管危险因素、合并症和结局。
结果
在 372 名患者中，76 名（20.4%）的 eGFR<45，65 名（17.5%）的 eGFR 在 45 到 59 之间，231 名（62.1%）的 eGFR≥60 mL/min/1.73 m。与其他组相比，在 eGFR<45 mL/min/1.73 m 组中，高血压、糖尿病、冠状动脉疾病、充血性心力衰竭、心脏瓣膜病和痛风的患病率明显更高（P=0.013，P=0.030，P=0.001，P<0.001，P=0.043 和 P<0.001）。与其他组相比，eGFR<45 mL/min/1.73 m 组的血红蛋白和总胆固醇水平较低（P<0.001 和 P=0.048）。eGFR<45 mL/min/1.73 m 组的血钾和尿酸水平明显较高（P<0.001 和 P<0.001）。多变量 Cox 比例风险模型表明，在调整这些变量后，eGFR<45 mL/min/1.73 m 是高分级 CAS 急性 IS 患者 5 年全因死亡率的显著危险因素（风险比=2.05；95%置信区间=1.31-3.21；P=0.002）。
结论
eGFR<45 mL/min/1.73 m 与高分级 CAS 急性 IS 患者 5 年全因死亡率增加相关。高分级 CAS 急性 IS 患者的慢性肾脏病是否积极治疗可以改善中风结局，需要进一步研究证实。
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