Umeno Tetsuya, Yamashita Aya, Mizota Takamitsu, Uramatsu Tadashi, Matsuo Takayuki
Department of Neurosurgery, Japan Community Health care Organization Isahaya general hospital; Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences.
Department of Neurology, Japan Community Health care Organization Isahaya General Hospital.
J Stroke Cerebrovasc Dis. 2022 May;31(5):106400. doi: 10.1016/j.jstrokecerebrovasdis.2022.106400. Epub 2022 Feb 24.
We sought to examine the validity of the total small-vessel disease (SVD) score in patients receiving maintenance hemodialysis by investigating its predictive value for recurrent stroke.
We identified 159 patients who showed acute ischemic stroke while receiving maintenance hemodialysis at our institute between January 1, 2008, and December 31, 2020; retrospectively calculated the total SVD score for each patient; and extracted data on demographic factors and comorbidities that could potentially affect recurrent stroke. Death was thought to be a potential competing risk for recurrent stroke because the perceived risk of death was considerably higher than the risk of recurrent stroke in these patients. Thus, we investigated the association between the total SVD score and recurrent stroke by analyzing the competing risk of non-stroke death.
The median (interquartile range) age was 72 (62-80) years. A total of 38 (23.9%) recurrent strokes occurred, and 69 (43.4%) patients died during the 505 patient-year follow-up study. The estimated cumulative incidence of recurrent stroke at five years was 13.3%, 13.4%, 24.1%, 50%, and 60% for scores of 0 to 4, respectively, and the hazard ratio (HR), adjusted for variables that had been reported to be risk factors of stroke in dialysis patients, per unit increase in the score was 1.72 (95% CI, 1.34-2.21; p<0.001).
A higher total SVD score was associated with an increased risk of recurrent stroke in patients undergoing maintenance hemodialysis.
我们试图通过研究总小血管疾病（SVD）评分对复发性卒中的预测价值，来检验其在接受维持性血液透析患者中的有效性。
我们确定了2008年1月1日至2020年12月31日期间在我院接受维持性血液透析时发生急性缺血性卒中的159例患者；回顾性计算每位患者的总SVD评分；并提取可能影响复发性卒中的人口统计学因素和合并症数据。死亡被认为是复发性卒中的一个潜在竞争风险，因为这些患者的死亡风险明显高于复发性卒中的风险。因此，我们通过分析非卒中死亡的竞争风险，研究总SVD评分与复发性卒中之间的关联。
年龄中位数（四分位间距）为72（62 - 80）岁。在505患者年的随访研究中，共发生38例（23.9%）复发性卒中，69例（43.4%）患者死亡。0至4分的患者五年复发性卒中估计累积发生率分别为13.3%、13.4%、24.1%、50%和60%，经调整已报道的透析患者卒中危险因素变量后，评分每增加一个单位，风险比（HR）为1.72（95%CI，1.34 - 2.21；p<0.001）。
在接受维持性血液透析的患者中，较高的总SVD评分与复发性卒中风险增加相关。
