Yu-Huan Song, Guang-Yan Cai, Yue-Fei Xiao
Department of Nephrology, Aerospace Center Hospital, Beijing, China.
Department of Nephrology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, National Clinical Research Center for Kidney Diseases, Beijing, China.
Front Neurol. 2023 Mar 22;14:1111865. doi: 10.3389/fneur.2023.1111865. eCollection 2023.
In patients undergoing hemodialysis, intracerebral hemorrhage (ICH) is the main cause of mortality among stroke subtypes. It is unclear whether, along with traditional cardiovascular risk factors, the risk factors unique to the uraemic environment, such as the abnormal metabolism of intact parathyroid hormone (iPTH), can contribute to the risk of ICH in these patients.
This retrospective case-control study included 25 patients undergoing hemodialysis with ICH at a single center between 30 June 2015 and 10 October 2022. The controls were 95 patients undergoing maintenance hemodialysis treated at the same dialysis center in July 2020. We compared the characteristics of patients with ICH with those of the control group to identify factors that contributed to the development of ICH.
Intracerebral hemorrhage (ICH) was located in the basal ganglia (14/25), cerebellum (6/25), and brainstem (6/25) in 25 patients. A total of 17 patients died in the first 16 days due to neurological complications. Univariate analysis showed significant differences in systolic BP, diastolic BP, iPTH, and alkaline phosphatase between the two groups ( < 0.05). Multivariate logistic regression analysis showed that higher systolic BP (OR, 1.053; 95% CI, 1.018-1.090; = 0.003) and higher iPTH (OR, 1.007; 95% CI, 1.003-1.012; = 0.001) were associated with the onset of ICH. ICH was predicted by systolic BP and iPTH by receiver operating characteristic (ROC) curve analysis, with areas under the curve (AUCs) of 0.732 and 0.624, respectively. The optimal cutoffs for systolic BP and iPTH were 151.9 mmHg and 295.4 pg./ml, respectively. Restricted cubic spline showed that the shape of the association of iPTH with the risk of ICH was approximately J-shaped (P for non-linearity <0.05).
Higher systolic BP and abnormal iPTH metabolism might be associated with ICH in patients undergoing hemodialysis. Comprehensive control of hypertension and iPTH may be a fundamental preventive strategy for ICH in these patients.
在接受血液透析的患者中，脑出血（ICH）是卒中亚型中导致死亡的主要原因。目前尚不清楚，除了传统的心血管危险因素外，尿毒症环境特有的危险因素，如完整甲状旁腺激素（iPTH）的代谢异常，是否会增加这些患者发生ICH的风险。
这项回顾性病例对照研究纳入了2015年6月30日至2022年10月10日期间在单一中心接受血液透析并发生ICH的25例患者。对照组为2020年7月在同一透析中心接受维持性血液透析的95例患者。我们比较了ICH患者与对照组的特征，以确定导致ICH发生的因素。
25例患者的脑出血（ICH）位于基底节（14/25）、小脑（6/25）和脑干（6/25）。共有17例患者在最初16天内因神经并发症死亡。单因素分析显示，两组间收缩压、舒张压、iPTH和碱性磷酸酶存在显著差异（<0.05）。多因素logistic回归分析显示，较高的收缩压（OR，1.053；95%CI，1.018-1.090；=0.003）和较高的iPTH（OR，1.007；95%CI，1.003-1.012；=0.001）与ICH的发生有关。通过受试者工作特征（ROC）曲线分析，收缩压和iPTH可预测ICH，曲线下面积（AUC）分别为0.732和0.624。收缩压和iPTH的最佳截断值分别为151.9mmHg和295.4pg./ml。受限立方样条显示，iPTH与ICH风险的关联形状近似J形（非线性P<0.05）。
较高的收缩压和iPTH代谢异常可能与血液透析患者的ICH有关。全面控制高血压和iPTH可能是预防这些患者发生ICH的基本策略。
