摘要
目的探讨肾小球滤过率(GFR)预测急性非心源性缺血性脑卒中复发和死亡的临床价值。方法 2015年1月至2017年3月湖州市第一人民医院收治的256例急性非心源性缺血性脑卒中患者,以改良的肾脏病膳食改良试验(MDRD)方程估测入院时的GFR(e GFR),将患者分为e GFR降低组[<60ml/(min·1.73m^2)和e GFR正常组[≥60ml/(min·1.73m^2)]。比较两组患者的空腹血糖、血肌酐、白细胞计数、C反应蛋白、D-二聚体水平,并于出院后随访1年,记录终点事件发生情况。结果与e GFR正常组比较,e GFR降低组糖尿病、高血压比例较高,入院时收缩压、NIHSS评分、空腹血糖、血肌酐、白细胞计数、C反应蛋白、D-二聚体较高,差异均有统计学意义(均P<0.05)。随访1年,发生终点事件46例(17.97%),其中脑卒中复发再入院36例,全因死亡10例。e GFR降低组终点事件发生率为28.79%(19/66)显著高于e GFR正常组的14.21%(27/190)(χ~2=7.062,P=0.008);终点事件组患者中e GFR水平[(64.29±18.29)ml/(min·1.73m^2)]显著低于非终点事件组患者[(88.50±20.15)ml/(min·1.73m^2)],差异有统计学意义(t=6.561,P<0.01)。多元Cox比例风险模型方程显示,e GFR<60ml/(min·1.73m^2)是急性非心源性缺血性脑卒中患者复发再入院和死亡的独立危险因素(HR=2.274,95%CI:1.514～6.129,P<0.01)。ROC曲线显示e GFR预测终点事件的AUC为0.842,灵敏度为86.39%,特异度78.44%,最佳诊断截点为56.95ml/(min·1.73m^2)。结论 e GFR降低者急性非心源性缺血性脑卒中后复发和死亡风险增加。
Objective To investigate the clinical value of glomerular filtration rate(GFR)in predicting recurrence and death in patients with acute non-cardiogenic ischemic stroke(NCIS).Methods 256 patients admitted for NCIS from January 2015 to March 2017 were enrolled,eGFR was estimated at admission using the modification of diet in renal disease equations,and the patients were divided into eGFR reduced group(<60 ml/(min·1.73 m^2)and eGFR normal group[60 ml/(min·1.73 m^2))Endpoint events were recorded during follow-up 1 year after discharge.Results Compared with eGFR normal group,the proportion of diabetes and hypertension,and SBP,NIHSS,FPG,Cr,WBC,CRP and d-dimer at admission were significantly higher in eGFR reduced group(all P<0.05).During follow-up 1 year,46 endpoint events(17.97%)occurred,of them,36 patients were hospitalized for stroke recurrence,and 10 patients died of all cause.The incidence of endpoint events in eGFR reduced group was 28.79%(19/66),significantly higher than 14.21%(27/190)in eGFR normal group(χ2=7.062,P<0.01).eGFR was significantly lower in patients with[(64.29 18.29)ml/(min·1.73 m^2)]than without[(88.50±20.15)ml/(min·1.73 m^2)](t=6.561,<0.01)endpoint events.The multivariate Cox proportional risk model equation showed that eGFR<60 ml/(min·1.73 m^2)was an independent risk factor for recurrence and death in patients with acute NCIS(HR=2.274,95%CI:1.514~6.129,P<0.01).ROC curve showed that the area under the curve of eGFR in predicting prognosis was 0.842,with sensitivity 86.39%and specificity 78.44%and the optimal diagnostic cut-off point was 56.95 ml/(min·1.73 m^2).Conclusion The risk of recurrence and death increases in patients with reduced eGFR after NCIS.
作者
钱铭净
张东伟
QIAN Mingjing;ZHANG Dongwei(Department of Neurology,Huzhou First People's Hospital,Huzhou 313000,China)
出处
《心电与循环》
2019年第2期110-114,127,共6页
Journal of Electrocardiology and Circulation
关键词
肾小球滤过率
缺血性脑卒中
脑卒中复发
再入院
终点事件
Glomerular filtration rate
Ischemic stroke
Recurrent stroke
Readmission
Endpoint events
