慢性肾脏病患者脑卒中的发生及其相关因素

目的 探讨慢性肾脏病（CKD）患者脑卒中的发生情况及其影响因素，以及颈动脉粥样硬化对其的影响。 方法 回顾性分析2007年1月至2007年12月在上海仁济医院住院治疗的700例CKD患者的脑卒中发生情况。将患者分为CKDⅠ~Ⅲ期、Ⅲ～Ⅴ期非透析患者及透析患者3组，比较其脑卒中发生率。随机选取409例患者行颈动脉多普勒超声检查，探讨颈动脉粥样硬化在脑卒中发生中的作用。Spearman相关因素及Logistic回归分析CKD患者脑卒中的相关影响因素。 结果 700例CKD患者中，67例（9.57%）曾经发生过≥1次脑卒中，显著高于普通人群。CKD患者脑卒中与肾小球滤过率（GFR）、年龄、收缩压（SBP）、C反应蛋白（CRP）、脂蛋白a（Lpa）、空腹血糖、前白蛋白、高密度脂蛋白（HDL）及颈动脉粥样硬化相关。Logistic回归分析显示，CKD脑卒中的影响因素包括SBP （β = 1.021，P = 0.042）、CRP（β = 1.008, P = 0.024）及颈动脉粥样硬化（β = 3.456，P = 0.025）。CKD患者颈动脉粥样硬化发生率普遍增高，且脑卒中患者的动脉粥样硬化发生率显著高于无脑卒中史患者（80.0%比47.4%，P < 0.01）。 结论 CKD患者脑卒中发生率高，原因与高血压、炎性反应及糖脂代谢紊乱有关。CKD脑卒中患者颈动脉粥样硬化发生率高，这可能有助于筛查CKD患者中脑卒中的发生。

Stroke and its related factors in chronic kidney disease patients

Objective To investigate the stroke occurrence of chronic kidney disease (CKD) and its related factors, especially the carotid atherosclerosis. Methods The data of stroke occurrence in 700 CKD patients hospitalized in Renji Hospital during 2007 were analyzed retrospectively. The incidences of stroke were compared among CKD [Ⅰ-Ⅱ, CKD Ⅲ-Ⅴ non-dialysis patients and dialysis patients. Carotid atherosclerosis of 409 CKD patients was examined by color Doppler ultrasound. The related factors were selected by Spearmnan correlation analysis and Logistic regression analysis. Results Of 700 CKD patients, 67 cases (9.57%) experienced at least one episode of stroke, which was much higher than that of general population. The related factors of stroke in CKD included GFR, age, SBP, CRP, Lpa, serum glucose, pre-albumin, HDL and carotid atherosclerosis. Logistic regression revealed that SBP (β=1.021, P=0.042), CRP (β=1.008, P=0.024) and carotid atherosclerosis (β =3.456, P=0.025) were risk factors of stroke in CKD. Incidence of carotid atherosclerosis was high (50.37%) in CKD patients, besides it was significantly higher in CKD patients with stroke history as compared to those without stroke history (80.0% vs 47.4%, P<0.01). Conclusions The incidence of stroke is quite high in CKD patients, which is closely associated with hypertension, inflammation and glyeolipid metabolism disorder. Carotid atherosclerosis is common in CKD patients with stroke, which may be helpful in screening cerebrovascular diseases in CKD patients.