|摘要||目的 探讨脑梗死患者脑血管狭窄程度和范围、脑白质损害(white matter lesions,WML)与慢性肾脏病(chronic kidney disease,CKD)的相关性及CKD的患病率.方法 对2008年1月至2013年2月收集的419例脑梗死患者进行分析,使用颈部血管彩色超声、经颅多普勒超声、头颅或颈部磁共振血管造影、头颈CT血管造影和数字减影血管造影评价脑血管狭窄程度和范围,使用改良Fazekas评分评价WML程度,使用改良的MDRD(Modification of Diet in Renal Disease)方程估测肾小球滤过率以评价肾功能,并分析其相关性.结果 (1)419例患者中,CKD患病率为12.4％ (52例).419例可分为大血管无狭窄组222例,轻度血管狭窄组63例,中度血管狭窄组63例,重度血管狭窄组44例及闭塞组27例,脑血管狭窄程度与CKD(Z=-3.070,P=0.002)及肾功能分级(r=0.194,P＜0.01)显著相关.(2)419例患者中,颅内血管狭窄组103例,颅外血管狭窄组45例,颅内外血管均狭窄组49例,各部位血管狭窄组与大血管无狭窄组比较得到CKD与颅内血管狭窄(x2=4.784,P=0.032)、颅外血管狭窄(x2=8.732,P=0.003)、颅内外血管狭窄(x2=5.308,P=0.021)均存在相关性.(3)175例采用头颅MRI评价WML程度的患者中,轻度WML82例,中度WML63例,重度WML30例,CKD分期与WML程度显著相关.(4)Logistic回归分析显示,CKD分期加重,血管狭窄程度越重(OR=0.485,95％ CI0.254 ～0.927,P=0.029),CKD患者颅外血管狭窄发生率更高(OR=0.395,95％ CI0.159 ～0.978,P=0.045),CKD分期在WML程度影响因素的分析中差异无统计学意义.结论 CKD患者脑血管狭窄程度更重,颅外血管狭窄发生率更高.脑梗死患者CKD患病率高于国内流行病学调查结果.
Objective To investigate the association between kidney function and cerebrovascular disease,and find out the prevalence of chronic kidney disease (CKD) in Chinese cerebral infarction patients.Methods Clinical data of 419 patients who underwent intra-and extracranial vessel examination in our department from January 2008 to February 2013 were retrospectively reviewed and analyzed.We evaluated the degree and extent of cerebrovascular stenosis by carotid duplex ultrasound,transcranial Doppler ultrasound,magnetic resonance angiography,computed tomography angiography and digital subtraction angiography,evaluated white matter lesions (WML) by MRI,and measured the kidney function by the adaption of MDRD (Modification of Diet in Renal Disease) equation.Then we analyzed the association between them in these patients.Results (1) In 419 patients,the prevalence of CKD was 12.4％ (52).The patients included 222 patients without cerebrovascular stenosis,63 patients with mild stenosis,63 patients with moderate stenosis,44 patients with severe stenosis and 27 patients with occlusion.CKD (Z =-3.070,P =0.002) and renal function (r =0.194,P ＜ 0.01) were associated with cerebrovascular stenosis.(2) In 419 patients,103 patients had intracranial vascular stenosis,45 patients had extracranial vascular stenosis,and 49 patients had intra-and extracranial vascular stenosis.Compared with the patients without stenosis,CKD was associated with intracranial stenosis (x2 =4.784,P =0.032),extracranial stenosis (x2 =8.732,P =0.003),and intra-and extracranial stenosis (x2 =5.308,P =0.021).(3) In 175 patients,including 82 patients with mild WML,63 patients with moderate WML,and 30 patients with severe WML,the CKD stage was significantly associated with the degree of WML (4) In the Logistic regression analysis,CKD was an independent risk factor of cerebrovascular stenosis (OR =0.485,95％ CI 0.254-0.927,P =0.029),and CKD (OR =0.395,95％ CI 0.159-0.978) was an independent risk factor of extracranial vascular stenosis,but not an independent risk factor of WML.Conclusions CKD patients suffer more severe cerebrovascular stenosis,and have higher prevalence of extracranial vascular stenosis.The prevalence of CKD in cerebral infraction patients is higher than that in the national epidemiological investigation.|