慢性肾脏病患者的卒中亚型
Stroke Subtype Among Individuals With Chronic Kidney Disease.
作者信息
Noor Salmi T, Bota Sarah E, Clarke Anna E, Petrcich William, Kelly Dearbhla, Knoll Greg, Hundemer Gregory L, Canney Mark, Tanuseputro Peter, Sood Manish M
机构信息
Department of Medicine, The Ottawa Hospital, University of Ottawa, ON, Canada.
Ottawa Hospital Research Institute, ON, Canada.
出版信息
Can J Kidney Health Dis. 2023 Oct 14;10:20543581231203046. doi: 10.1177/20543581231203046. eCollection 2023.
BACKGROUND
It is widely accepted that there is a stepwise increase in the risk of acute ischemic stroke with chronic kidney disease (CKD). However, whether the risk of specific ischemic stroke subtypes varies with CKD remains unclear.
OBJECTIVE
To assess the association between ischemic stroke subtypes (cardioembolic, arterial, lacunar, and other) classified using the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) and CKD stage.
DESIGN
retrospective cohort study.
SETTING
Ontario, Canada.
PATIENTS
A total of 17 434 adults with an acute ischemic stroke in Ontario, Canada between April 1, 2002 and March 31, 2013, with an estimated glomerular filtration rate (eGFR) measurement or receipt of maintenance dialysis captured in a stroke registry were included.
MEASUREMENTS
Kidney function categorized as an eGFR of ≥60, 30-59, <30 mL/min/1.73 m, or maintenance dialysis. Ischemic stroke classified by TOAST included arterial, cardioembolic, lacunar, and other (dissection, prothrombotic state, cortical vein/sinus thrombosis, and vasculitis) types of strokes.
METHODS
Adjusted regression models.
RESULTS
In our cohort, 58.9% had an eGFR of ≥60, 34.7% an eGFR of 30-59, 6.0% an eGFR of <30 and 0.5% were on maintenance dialysis (mean age of 73 years; 48% women). Cardioembolic stroke was more common in patients with non-dialysis-dependant CKD (eGFR 30-59: 50.4%, adjusted odds ratio [OR] 1.20, 95% confidence interval [CI]: 1.02, 1.44; eGFR<30: 50.6%, OR 1.21, 95% CI: 1.02, 1.44), whereas lacunar stroke was less common (eGFR 30-59: 22.7% OR 0.85, 95% CI: 0.77, 0.93; eGFR <30: 0.73, 95% CI: 0.61, 0.88) compared with those with an eGFR ≥60. In stratified analyses by age and CKD, lacunar strokes were more frequent in those aged less than 65 years, whereas cardioembolic was higher in those aged 65 years and above.
LIMITATIONS
TOAST classification was not captured for all patients.
CONCLUSION
Non-dialysis CKD was associated with a higher risk of cardioembolic stroke, whereas an eGFR ≥60 mL/min/1.73 m was associated with a higher risk of lacunar stroke. Detailed stroke subtyping in CKD may therefore provide mechanistic insights and refocus treatment strategies in this high-risk population.
背景
人们普遍认为，慢性肾脏病（CKD）会使急性缺血性卒中的风险逐步增加。然而，特定缺血性卒中亚型的风险是否会因CKD而有所不同仍不清楚。
目的
评估使用急性卒中治疗中ORG 10172试验（TOAST）分类的缺血性卒中亚型（心源性栓塞性、动脉性、腔隙性和其他）与CKD分期之间的关联。
设计
回顾性队列研究。
地点
加拿大安大略省。
患者
纳入了2002年4月1日至2013年3月31日期间在加拿大安大略省发生急性缺血性卒中的17434名成年人，这些患者的估计肾小球滤过率（eGFR）测量值或维持性透析情况记录在卒中登记处。
测量指标
肾功能分为eGFR≥60、30 - 59、<30 mL/min/1.73 m²或维持性透析。根据TOAST分类的缺血性卒中包括动脉性、心源性栓塞性、腔隙性和其他（夹层、血栓前状态、皮质静脉/窦血栓形成和血管炎）类型的卒中。
方法
调整后的回归模型。
结果
在我们的队列中，58.9%的患者eGFR≥60，34.7%的患者eGFR为30 - 59，6.0%的患者eGFR<30，0.5%的患者接受维持性透析（平均年龄73岁；48%为女性）。心源性栓塞性卒中在非透析依赖型CKD患者中更常见（eGFR 30 - ：50.4%，调整后的优势比[OR] 1.20，95%置信区间[CI]：1.02，1.44；eGFR<30：50.6%，OR 1.21，95% CI：1.02，1.44），而腔隙性卒中则较少见（eGFR 30 - 59：22.7%，OR 0.85，95% CI：0.77，0.93；eGFR<30：20.73，95% CI：0.61，0.88），与eGFR≥60的患者相比。在按年龄和CKD进行的分层分析中，腔隙性卒中在年龄小于65岁的患者中更常见，而心源性栓塞性卒中在65岁及以上的患者中更高发。
局限性
并非所有患者都进行了TOAST分类。
结论
非透析CKD与心源性栓塞性卒中风险较高相关联，而eGFR≥60 mL/min/1.73 m²与腔隙性卒中风险较高相关联。因此，对CKD患者进行详细的卒中亚型分类可能有助于深入了解发病机制，并为这一高危人群重新调整治疗策略。
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