国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2009年
6期
428-433
,共6页
肾功能衰竭,慢性%患病率%卒中%危险因素%预后
腎功能衰竭,慢性%患病率%卒中%危險因素%預後
신공능쇠갈,만성%환병솔%졸중%위험인소%예후
kidney failure,chronic%prevalence%stroke%risk factors%prognosis
目的 探讨卒中人群中慢性肾脏病(chronic kidney disease,CKD)的患病率以及该类患者的卒中危险因素和预后特点.方法 连续收集270例住院治疗的急性卒中患者,横贯性评价其CKD患病情况,比较270例卒中患者中入院美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分相近的53例CKD患者与106例无CKD患者的各种危险因素和近期预后.肾小球滤过率(glomerular filtration rate,GFR)＜60 ml/(min·1.73 m2)和(或)随机尿白蛋白/尿肌酐比值(albumin-to-creatinine-ratios,ACR)＞30 mg/g且持续3个月以上者定义为CKD,依据肾脏病饮食改良(Modification of Diet in Renal Disease equation,MDRD)简化公式估算GFR.近期预后采用改良Rankin量表(modified Rankin Scale,mRS)评价.结果 本组卒中患者CXD患病率为19.6%,主要为早、中期CKD.CKD组高血压(81.13%)、糖尿病(33.96%)和卒中病史(45.28%)比例均显著高于无CKD组(分别为64.15%、18.86%和27.36%)(P均＜0.05);伴CKD者收缩压[(151.74±20.98)mm Hg]和低密度脂蛋白[(3.03±0.96)mmol/L]显著高于无CKD组[收缩压为(144.30±21.64)mm Hg,低密度脂蛋白为(2.75±0.76)mmol/L](P均＜0.05);另外,CKD组红细胞沉降率(39 mm/h,中位数)、超敏C-反应蛋白(5.12 mg/L,中位数)、甲状旁腺素[(81.01±26.78)pg/ml]水平均显著高于无CKD组[分别为20 mm/h、3.36 mg/L和(46.95±24.63)pg/m]](P均＜0.05);CKD组还存在低血钙和高血磷的改变趋势.CKD组发病3个月后mRS评分≥13分的患者比例(66.03%)显著高于无CKD组(46.23%)(P＜0.05),3个月时的病死率(9.43%)也有增高的趋势(P=0.073).结论 卒中人群的CKD患病率较高,主要为早、中期CKD.伴CKD者卒中危险因素多于无CKD者,且预后也更差.
目的 探討卒中人群中慢性腎髒病(chronic kidney disease,CKD)的患病率以及該類患者的卒中危險因素和預後特點.方法 連續收集270例住院治療的急性卒中患者,橫貫性評價其CKD患病情況,比較270例卒中患者中入院美國國立衛生研究院卒中量錶(National Institutes of Health Stroke Scale,NIHSS)評分相近的53例CKD患者與106例無CKD患者的各種危險因素和近期預後.腎小毬濾過率(glomerular filtration rate,GFR)＜60 ml/(min·1.73 m2)和(或)隨機尿白蛋白/尿肌酐比值(albumin-to-creatinine-ratios,ACR)＞30 mg/g且持續3箇月以上者定義為CKD,依據腎髒病飲食改良(Modification of Diet in Renal Disease equation,MDRD)簡化公式估算GFR.近期預後採用改良Rankin量錶(modified Rankin Scale,mRS)評價.結果 本組卒中患者CXD患病率為19.6%,主要為早、中期CKD.CKD組高血壓(81.13%)、糖尿病(33.96%)和卒中病史(45.28%)比例均顯著高于無CKD組(分彆為64.15%、18.86%和27.36%)(P均＜0.05);伴CKD者收縮壓[(151.74±20.98)mm Hg]和低密度脂蛋白[(3.03±0.96)mmol/L]顯著高于無CKD組[收縮壓為(144.30±21.64)mm Hg,低密度脂蛋白為(2.75±0.76)mmol/L](P均＜0.05);另外,CKD組紅細胞沉降率(39 mm/h,中位數)、超敏C-反應蛋白(5.12 mg/L,中位數)、甲狀徬腺素[(81.01±26.78)pg/ml]水平均顯著高于無CKD組[分彆為20 mm/h、3.36 mg/L和(46.95±24.63)pg/m]](P均＜0.05);CKD組還存在低血鈣和高血燐的改變趨勢.CKD組髮病3箇月後mRS評分≥13分的患者比例(66.03%)顯著高于無CKD組(46.23%)(P＜0.05),3箇月時的病死率(9.43%)也有增高的趨勢(P=0.073).結論 卒中人群的CKD患病率較高,主要為早、中期CKD.伴CKD者卒中危險因素多于無CKD者,且預後也更差.
목적 탐토졸중인군중만성신장병(chronic kidney disease,CKD)적환병솔이급해류환자적졸중위험인소화예후특점.방법 련속수집270례주원치료적급성졸중환자,횡관성평개기CKD환병정황,비교270례졸중환자중입원미국국립위생연구원졸중량표(National Institutes of Health Stroke Scale,NIHSS)평분상근적53례CKD환자여106례무CKD환자적각충위험인소화근기예후.신소구려과솔(glomerular filtration rate,GFR)＜60 ml/(min·1.73 m2)화(혹)수궤뇨백단백/뇨기항비치(albumin-to-creatinine-ratios,ACR)＞30 mg/g차지속3개월이상자정의위CKD,의거신장병음식개량(Modification of Diet in Renal Disease equation,MDRD)간화공식고산GFR.근기예후채용개량Rankin량표(modified Rankin Scale,mRS)평개.결과 본조졸중환자CXD환병솔위19.6%,주요위조、중기CKD.CKD조고혈압(81.13%)、당뇨병(33.96%)화졸중병사(45.28%)비례균현저고우무CKD조(분별위64.15%、18.86%화27.36%)(P균＜0.05);반CKD자수축압[(151.74±20.98)mm Hg]화저밀도지단백[(3.03±0.96)mmol/L]현저고우무CKD조[수축압위(144.30±21.64)mm Hg,저밀도지단백위(2.75±0.76)mmol/L](P균＜0.05);령외,CKD조홍세포침강솔(39 mm/h,중위수)、초민C-반응단백(5.12 mg/L,중위수)、갑상방선소[(81.01±26.78)pg/ml]수평균현저고우무CKD조[분별위20 mm/h、3.36 mg/L화(46.95±24.63)pg/m]](P균＜0.05);CKD조환존재저혈개화고혈린적개변추세.CKD조발병3개월후mRS평분≥13분적환자비례(66.03%)현저고우무CKD조(46.23%)(P＜0.05),3개월시적병사솔(9.43%)야유증고적추세(P=0.073).결론 졸중인군적CKD환병솔교고,주요위조、중기CKD.반CKD자졸중위험인소다우무CKD자,차예후야경차.
Objective To investigate the prevalence of chronic kidney disease (CKD) in patients with acute stroke and the risk factors and prognostic characteristics in these patients.Methods A total of 270 consecutive hospitalized patients with acute stroke was recruited, and their CKD was evaluated transversally. Various risk factors and short-term prognosis of 53 patients with CKD whose National Institutes of Health Stroke Scale (NIHSS) scores were similar at admission among the 270 patients with stroke were compared to those of 106 patients without CKD. CKD was defined as glomerular filtration rate (GFR) ＜ 60 ml/(min·1.73 m2) and (or) random urinary albumin-to-creatinine ratios (ACR) ＞ 30 mg/g, and continued for more than 3 months. GFR was estimated according to the simplified Modification of Diet in Renal Disease (MDRD) equation, The modified Rankin Scale (mRS) was used to evaluate the shortterm prognosis. Results The prevalence of CKD in these patients was 19.6%, and most of them were early-and middle-stage CKD. The proportions of the histories of hypertension (81.13%), diabetes mellitus (33.96%), and stroke (45.28%) in patients with CKD were significantly higher than those in patients without CKD (64.15%, 18.86% and 27.36%,respectively, all P＜0.05). The mean levels of systolic pressure (151.74±20.98 mm Hg) and low density lipoprotein (3.03±0.96 mmol/L) in patients with CKD were significantly higher than those in patients without CKD (systolic pressure was 144.44±21.13 mm Hg, and low density lipoprotein was 2.75±0.76 mmol/L, all P＜0.05). In addition, the levels of erythrocytes sedimentation rate(median, 39 mm/h), high sensitive C-reactive protein (median,5.12 mg/L) and parathyroid hormone (81.01±26.78 pg/ml) were significantly higher than those in patients without CKD (they were 20 mm/h, 3.36 mg/L, and 46.95±24.63 pg/ml,respectively, all P＜0.05). There was a changing trend in low serum calcium and high serum phosphorus in patients with CKD. The proportion of the patients whose mRS score ≥ 3 at 3 months after the onset in patients with CKD was significantly higher than that in patients without CKD (66.03% vs 46.23%, P＜0.05). The mortality at 3 months (9.43%) also had an increasing tendency (P=0.073). Conclusions The prevalence of CKD was higher among the stroke population, and most of them were early-and middle-stage CKD. The stroke patients with CKD had more risk factors and worse prognosis than those without.
