摘要
目的探讨肾功能水平与急性缺血性脑卒中患者早期神经功能恶化(END)和短期神经功能预后之间的相关性。方法连续纳入2017年9月至2019年9月南京医科大学附属脑科医院脑血管病救治中心收治的急性缺血性脑卒中患者403例。END定义为入院72 h内NIHSS得分增加≥2分。采用单因素Logistic回归、多因素Logistic回归和倾向性评分匹配(PSM)方法评估肾功能与END和短期功能预后之间的相关性。结果在研究纳入的403例患者中,89例(22.1%)发生了END。多因素Logistic分析和PSM结果显示,与肾小球滤过率(eGFR)≥90 ml/(min·1.73 m^(2))患者相比,eGFR<60 ml/(min·1.73 m^(2))患者有较高的END风险(多因素Logistic:OR=3.58,95%CI:1.55~8.31,P=0.003;PSM分析:OR=3.62,95%CI:1.18~11.13,P=0.025)。慢性肾脏疾病(CKD)患者的END风险比无CKD患者增高约2倍(多因素Logistic:OR=3.05,95%CI:1.35~6.88,P=0.007;PSM分析:OR=3.04,95%CI:1.02~9.10,P=0.046)。共388例患者完成3个月随访,其中预后不良72例(18.6%),预后良好316例(81.4%)。多因素回归分析与PSM结果显示,eGFR 60~89 ml/(min·1.73 m^(2))患者(多因素Logistic:OR=2.37,95%CI:1.07~5.22,P=0.033;PSM分析:OR=4.39,95%CI:1.45~13.28,P=0.009)和eGFR<60 ml/(min·1.73 m^(2))患者(多因素Logistic:OR=3.69,95%CI:1.23~11.07,P=0.020;PSM分析:OR=4.80,95%CI:1.02~22.61,P=0.047)的短期不良功能预后的风险显著高于eGFR≥90 ml/(min·1.73 m^(2))的患者。结论较低的基线eGFR与急性缺血性卒中患者的END和短期功能预后不良独立相关。
Objective To investigate the association between renal function and early neurologic deterioration(END)or short-term functional outcome in patients with acute ischemic stroke.Methods Four hundred and three patients with acute ischemic stroke admitted to cerebrovascular disease treatment center of Nanjing Brain Hospital Affiliated to Nanjing Medical University from September 2017 to September 2019 were included.END was defined as an increase of≥2 points in the NIHSS within 72 h of stroke onset.Univariate Logistic regression,multivariate Logistic regression and propensity score matching(PSM)were used to evaluate the correlation between renal function and END or short-term functional outcome.Results Of the 403 patients included in the study,89 cases(22.1%)developed END.Multivariate Logistic analysis and PSM showed that compared with that in patients with estimated glomerular filtration rate(eGFR)≥90 ml/(min·1.73 m^(2)),patients with eGFR<60 ml/(min·1.73 m^(2))had higher risk of END(multivariate Logistic:OR=3.58,95%CI:1.55-8.31,P=0.003;PSM:OR=3.62,95%CI:1.18-11.13,P=0.025).In addition,chronic kidney disease(CKD)patients were about 2 times more likely to develop END than non-CKD patients(multivariate Logistic:OR=3.05,95%CI:1.35-6.88,P=0.007;PSM:OR=3.04,95%CI:1.02-9.10,P=0.046).A total of 388 patients were followed up for 3 months,of which 72 cases(18.6%)had poor outcomes and 316 cases(81.4%)had favorable outcome.Multivariate Logistic regression analysis and PSM showed that the risk of poor short-term functional outcomes in patients with eGFR 60-89 ml/(min·1.73 m^(2))(multivariate Logistic:OR=2.37,95%CI:1.07-5.22,P=0.033;PSM:OR=4.39,95%CI:1.45-13.28,P=0.009)and patients with eGFR<60 ml/(min·1.73 m^(2))(multivariate Logistic:OR=3.69,95%CI:1.23-11.07,P=0.020;PSM:OR=4.80,95%CI:1.02-22.61,P=0.047)were significantly higher than that in patients with eG FR≥90 ml/(min·1.73 m^(2)).Conclusion Low baseline eG FR is independently associated with END and poor short-term functional outcome in patients with acute ischemic stroke.
作者
张尧
蓝文雅
李顺
姜海波
邱峰
杜明洋
曹辉
ZHANG Yao;LAN Wen-ya;LI Shun(Department of Cerebrovascular Disease Treatment Center,Nanjing Brain Hospital Affiliated to Nanjing Medical University,Nanjing 210029,China)
出处
《临床神经病学杂志》
CAS
2021年第4期241-246,共6页
Journal of Clinical Neurology
基金
国家自然科学基金资助项目(82001260)。
关键词
肾功能
急性缺血性脑卒中
早期神经功能恶化
短期功能预后
倾向性评分匹配分析
renal function
acute ischemic stroke
early neurological deterioration
short-term functional outcome
propensity score matching analysis
