中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2015年
6期
469-474
,共6页
杨亚超%刘英霞%张江山%张金彪
楊亞超%劉英霞%張江山%張金彪
양아초%류영하%장강산%장금표
脑出血%肾小球滤过率%白蛋白尿%半胱氨酸蛋白酶抑制物C%生物学标记
腦齣血%腎小毬濾過率%白蛋白尿%半胱氨痠蛋白酶抑製物C%生物學標記
뇌출혈%신소구려과솔%백단백뇨%반광안산단백매억제물C%생물학표기
Cerebral hemorrhage%Glomerular filtration rate%Albuminuria%Cystatin C%Biological markers
目的 探讨脑出血患者肾脏损伤标志物水平与脑微出血的相关性.方法 横断面研究了129例脑出血患者,应用3.0T磁共振磁敏感加权成像确定是否存在脑微出血;根据简化肾脏病膳食改良试验公式推算其肾小球滤过率,应用免疫比浊法检测尿中微量白蛋白含量,尿肌酐应用酶法检测,应用颗粒增强免疫比浊法测定胱抑素C水平.结果 129例脑出血患者中有86例(66.7％)存在脑微出血.与不存在脑微出血患者相比,存在脑微出血的脑出血患者被评估的肾小球滤过率(ml ·min-1· 1.73 m-2)水平明显降低(非脑微出血组为78.07±18.69,脑微出血组为61.59±17.08,t =3.672,P＜0.01),尿白蛋白与肌酐比值(mg/g;非脑微出血组为20.47±9.03,脑微出血组为35.24±14.83,t=3.823,P＜0.01)和胱抑素C的水平(mg/L;非脑微出血组为0.98±0.09,脑微出血组为1.31±0.13,t=4.739,P＜0.01)明显增高.多变量Logistic分析表明:在脑出血患者中校正年龄、性别、高血压、糖尿病、高脂血症、吸烟、喝酒、腔隙性脑梗死及脑白质疏松及超敏C反应蛋白后,肾脏损伤标志物水平(被评估的肾小球滤过率、尿白蛋白与肌酐比值及胱抑素C)的改变仍伴随脑微出血的存在,其比值比(95％ CI)分别为2.573 (1.172～5.315)、2.735 (1.247 ～6.246)和2.976(1.764～6.968).胱抑素C对脑微出血有较好的诊断价值,其曲线下面积为0.835 (95％CI0.791 ～0.878);被评估的肾小球滤过率水平的减低伴随着脑微出血数量的增加(P=0.038,R2 total=0.216),尿白蛋白与肌酐比值和血清胱抑素C水平的增加也伴随着脑微出血数量的增加(P=0.024,R2 total =0.312;P=0.013,R2 total=0.375).结论 脑出血患者的肾脏损伤标志物水平与脑微出血的存在具有相关关系,且与脑微出血的数量具有相关性.胱抑素C有可能成为脑出血患者存在脑微出血的标志.
目的 探討腦齣血患者腎髒損傷標誌物水平與腦微齣血的相關性.方法 橫斷麵研究瞭129例腦齣血患者,應用3.0T磁共振磁敏感加權成像確定是否存在腦微齣血;根據簡化腎髒病膳食改良試驗公式推算其腎小毬濾過率,應用免疫比濁法檢測尿中微量白蛋白含量,尿肌酐應用酶法檢測,應用顆粒增彊免疫比濁法測定胱抑素C水平.結果 129例腦齣血患者中有86例(66.7％)存在腦微齣血.與不存在腦微齣血患者相比,存在腦微齣血的腦齣血患者被評估的腎小毬濾過率(ml ·min-1· 1.73 m-2)水平明顯降低(非腦微齣血組為78.07±18.69,腦微齣血組為61.59±17.08,t =3.672,P＜0.01),尿白蛋白與肌酐比值(mg/g;非腦微齣血組為20.47±9.03,腦微齣血組為35.24±14.83,t=3.823,P＜0.01)和胱抑素C的水平(mg/L;非腦微齣血組為0.98±0.09,腦微齣血組為1.31±0.13,t=4.739,P＜0.01)明顯增高.多變量Logistic分析錶明:在腦齣血患者中校正年齡、性彆、高血壓、糖尿病、高脂血癥、吸煙、喝酒、腔隙性腦梗死及腦白質疏鬆及超敏C反應蛋白後,腎髒損傷標誌物水平(被評估的腎小毬濾過率、尿白蛋白與肌酐比值及胱抑素C)的改變仍伴隨腦微齣血的存在,其比值比(95％ CI)分彆為2.573 (1.172～5.315)、2.735 (1.247 ～6.246)和2.976(1.764～6.968).胱抑素C對腦微齣血有較好的診斷價值,其麯線下麵積為0.835 (95％CI0.791 ～0.878);被評估的腎小毬濾過率水平的減低伴隨著腦微齣血數量的增加(P=0.038,R2 total=0.216),尿白蛋白與肌酐比值和血清胱抑素C水平的增加也伴隨著腦微齣血數量的增加(P=0.024,R2 total =0.312;P=0.013,R2 total=0.375).結論 腦齣血患者的腎髒損傷標誌物水平與腦微齣血的存在具有相關關繫,且與腦微齣血的數量具有相關性.胱抑素C有可能成為腦齣血患者存在腦微齣血的標誌.
목적 탐토뇌출혈환자신장손상표지물수평여뇌미출혈적상관성.방법 횡단면연구료129례뇌출혈환자,응용3.0T자공진자민감가권성상학정시부존재뇌미출혈;근거간화신장병선식개량시험공식추산기신소구려과솔,응용면역비탁법검측뇨중미량백단백함량,뇨기항응용매법검측,응용과립증강면역비탁법측정광억소C수평.결과 129례뇌출혈환자중유86례(66.7％)존재뇌미출혈.여불존재뇌미출혈환자상비,존재뇌미출혈적뇌출혈환자피평고적신소구려과솔(ml ·min-1· 1.73 m-2)수평명현강저(비뇌미출혈조위78.07±18.69,뇌미출혈조위61.59±17.08,t =3.672,P＜0.01),뇨백단백여기항비치(mg/g;비뇌미출혈조위20.47±9.03,뇌미출혈조위35.24±14.83,t=3.823,P＜0.01)화광억소C적수평(mg/L;비뇌미출혈조위0.98±0.09,뇌미출혈조위1.31±0.13,t=4.739,P＜0.01)명현증고.다변량Logistic분석표명:재뇌출혈환자중교정년령、성별、고혈압、당뇨병、고지혈증、흡연、갈주、강극성뇌경사급뇌백질소송급초민C반응단백후,신장손상표지물수평(피평고적신소구려과솔、뇨백단백여기항비치급광억소C)적개변잉반수뇌미출혈적존재,기비치비(95％ CI)분별위2.573 (1.172～5.315)、2.735 (1.247 ～6.246)화2.976(1.764～6.968).광억소C대뇌미출혈유교호적진단개치,기곡선하면적위0.835 (95％CI0.791 ～0.878);피평고적신소구려과솔수평적감저반수착뇌미출혈수량적증가(P=0.038,R2 total=0.216),뇨백단백여기항비치화혈청광억소C수평적증가야반수착뇌미출혈수량적증가(P=0.024,R2 total =0.312;P=0.013,R2 total=0.375).결론 뇌출혈환자적신장손상표지물수평여뇌미출혈적존재구유상관관계,차여뇌미출혈적수량구유상관성.광억소C유가능성위뇌출혈환자존재뇌미출혈적표지.
Objective To investigate the relationship between biomarkers of renal function and cerebral microbleeds (CMBs) in cerebral hemorrhage patients.Methods This is a cross-sectional study including a total of 129 patients with cerebral hemorrhage.All patients underwent susceptibility weighted 3.0 T MRI.The presence and number of CMBs on susceptibility weighted MRI were independently interpreted.We calculated the urinary albumin/creatinine ratio (UACR) from morning spot urine and the estimated glomerular filtration rate (eGFR) in serum samples.Serum cystatin C (CysC) was measured using the automated particle-enhanced turbidimetric immunoassay.Results Among 129 patients with cerebral hemorrhage,86 (66.7％) had CMBs on susceptibility-weighted imaging.UACR (mg/g;20.47 ± 9.03 vs 35.24±14.83,t=3.823,P＜0.01)andCysC (mg/L;0.98±0.09vs 1.31 ±0.13,t=4.739,P＜0.01) levels were higher in the patients with CMBs than those without,and the eGFR (ml · min-1 · 1.73 m 2) was lower in the patients with CMBs than those without (78.07 ± 18.69 vs 61.59 ± 17.08,t =3.672,P ＜0.01).A Logistic regression analysis indicated that the levels of kidney impairment biomarkers were significantly associated with the prevalence of CMBs in cerebral hemorrhage patients after an adjustment for age,sex and other risk factors.The odds ratio (OR) and 95％ CI of each kidney biomarkers (eGFR,UACR,and CysC) for the CMBs status were 2.573 (1.172-5.315),2.735 (1.247-6.246)and 2.976 (1.764-6.968),respectively.CysC exhibited fair diagnostic value for CMBs,with an area under the curve of 0.835 (95％ CI 0.791-0.878).Furthermore,there were negative correlations between eGFR and the the number of CMBs (P =0.038,R2 total =0.216).There was a positive correlation between UACR,CysC and number of CMBs (P =0.024,R2 total =0.312;P =0.013,R2 total =0.375).Conclusions Elevated levels of kidney biomarkers are associated with the presence of CMBs in cerebral hemorrhage patients,independent of conventional risk factors.CysC may be a potential diagnostic biomarker for CMBs in cerebral hemorrhage patients.
