Department of Neurology, Stroke Center.
Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey.
Neurologist. 2022 Jul 1;27(4):157-163. doi: 10.1097/NRL.0000000000000388.
Previous studies demonstrating the association between renal functions and cerebral small vessel diseases have usually focused on white matter hyperintensity in the general population or lacunar stroke patients. This study aimed to investigate the effects of renal function on imaging markers of cerebral small vessel disease and etiologic subtypes of stroke in patients with acute ischemic stroke or transient ischemic attack.
A total of 356 consecutive patients with acute ischemic stroke or transient ischemic attack who were admitted to the Stroke Unit and underwent brain magnetic resonance imaging were evaluated. Demographic data, vascular risk factors, stroke etiology, estimated glomerular filtration rate and severity of cerebral small vessel disease markers, and total cerebral small vessel disease burden were evaluated.
There was a significant inverse correlation between estimated glomerular filtration rate and total number of lacunes, periventricular and deep subcortical Fazekas scores, grade of enlarged perivascular spaces in the centrum semiovale, lobar and total cerebral microbleeds, and total cerebral small vessel disease burden. Impaired renal function was an independent risk factor for the presence of lacunes, deep cerebral microbleeds, and increased total burden. Renal function impairment and periventricular white matter hyperintensities were significantly associated with the etiologic subgroup of small vessel occlusion. The results were still significant after the exclusion of patients below 50 years of age.
Our results indicate that there is a relationship between renal function impairment and increased total burden, as well as acute ischemic stroke/transient ischemic attack due to small vessel occlusion.
先前的研究表明，肾功能与脑小血管疾病之间存在关联，这些研究通常集中在普通人群或腔隙性卒中患者的脑白质高信号上。本研究旨在探讨肾功能对急性缺血性卒中和短暂性脑缺血发作患者脑小血管疾病影像学标志物和卒中病因亚型的影响。
对 356 例急性缺血性卒中和短暂性脑缺血发作患者进行评估，这些患者均入住卒中单元并接受了脑部磁共振成像检查。评估了人口统计学数据、血管危险因素、卒中病因、肾小球滤过率估计值和脑小血管疾病标志物的严重程度以及脑小血管疾病总负担。
肾小球滤过率与腔隙数量、脑室周围和深部皮质下 Fazekas 评分、脑白质深部和脑叶及总脑微出血的血管周围间隙扩大程度以及脑小血管疾病总负担呈显著负相关。肾功能不全是腔隙、深部脑微出血和总负担增加的独立危险因素。肾功能不全和脑室周围白质高信号与小血管闭塞的病因亚组显著相关。排除年龄在 50 岁以下的患者后，结果仍然显著。
我们的研究结果表明，肾功能不全与总负担增加以及小血管闭塞引起的急性缺血性卒中和短暂性脑缺血发作之间存在相关性。
