肾功能不全与伴非瓣膜性房颤的急性脑梗死患者不良预后的关系

目的 探讨肾功能不全与伴非瓣膜性房颤的急性脑梗死患者不良预后的关系.方法 纳入2013年1月~2015年1月于首都医科大学宣武医院神经内科住院的伴非瓣膜性心房颤动的急性脑梗死患者266例,使用肾脏病饮食改良(MDRD)简化公式计算肾小球滤过率估计值(eGFR),按照eGFR将患者分为肾功能不全组(36例)和无肾功能不全组(230例),出院后1年通过电话或门诊随访,观察不良卒中结局,包括全因死亡、卒中复发、联合终点事件(卒中或死亡)、卒中性残疾.结果 (1)肾功能不全组患者中,年龄≥65岁者的比例高于无肾功能不全组,差异有统计学意义94.4%(34/36)比70.0%(161/230),P=0.002];(2)肾功不全组和无肾功能不全组比较,出院后1年不良预后结局事件发生率的差异有统计学意义(50.5%比29.6%,P=0.021);(3)多因素Logistic分析显示,肾功能不全为伴非瓣膜性房颤的急性脑梗死患者1年内发生不良卒中结局事件的独立危险因素,随着eGFR下降,患者不良结局事件的发生率增高(OR=1.485,P<0.05).结论 对于伴非瓣膜性房颤的急性脑梗死患者,肾功能随着年龄的增加而下降,肾功能不全是伴非瓣膜性房颤的急性脑梗死患者长期不良预后结局的独立预测因子.

Correlation between renal insufficiency and prognosis of acute cerebral infarction patients with non-valvular atrial fibrillation

Objective To investigate the correlation between renal insufficiency and prognosis of acute ischaemic stroke patients with non-valvular atrial fibrillation.Methods Totals of 266 acute isch-aemic stroke patients with non-valvular atrial fibrillation in Neurology Department, Xuan Wu Hospital between January 2013 and January 2015 were included. Estimated glomerular filtration rate (eGFR) was estimated by revised Modification of Diet in Renal Disease (MDRD) equation. Renal inadequacy is defined as eGFR<60 ml/(min·1.73 m2). There were 36 cases in renal inadequacy group and 230 cases in renal adequacy group. The followed-up du-ration lasted for 1 year. The association between eGFR and poor stroke outcomes was evaluated by multivariate analysis.Results (1) The proportion of patients older than 65 years in renal inadequacy group was bigger than renal adequacy group94.4%(34/36) vs 70.0%(161/230),P=0.002]. (2)There was statistical difference be-tween renal inadequacy group and renal adequacy group on rate of outcome events (50.5% vs 29.6%,P=0.021). (3)Multivariate logistic regression analysis showed that eGFR<60 ml/(min·1.73 m2) was an independent risk factor for the occurrence of endpoint events within 1 year after acute cerebral infarction. The worse renal function was, the higher incidence of poor stroke outcomes would be(OR=1.485,P<0.05).Conclusions The renal function would become worse with the growth of age in acute ischemic stroke patients with non-valvular atrial fibrillation. Renal insufficiency is an independent risk factor for the occurrence of endpoint events in acute cere-bral infarction patients with non-valvular atrial fibrillation.