西安地区中青年急性卒中患者肾小球滤过率估计值与1年死亡的关系研究

doi:10.3969/j.issn.1673-5765.2022.01.010

摘要/Abstract

摘要：

目的探讨西安地区中青年急性卒中患者肾小球滤过率估计值（estimated glomerular filtration rate， eGFR）水平与1年死亡的关系。

方法基于西安卒中登记研究数据库平台，回顾性分析西安市4所三级甲等医院2015年1-12月连续入院的急性卒中患者的临床和随访资料，筛选出年龄在18～64岁的中青年急性卒中患者。将eGFR按照从低到高的水平排序后进行5等分组（Q1～Q5），比较不同eGFR水平组间临床特征和1年全因死亡率的差异；通过多因素Cox回归分析，探讨中青年急性卒中患者eGFR水平与1年全因死亡的关系，并采用 Kaplan-Meier法进行不同eGFR水平组的生存分析。

结果最终纳入中青年急性卒中患者1405例，平均年龄53.9±8.0岁，男性961例（68.4%），女性444 例（31.6%）。校正相关混杂因素后，多因素Cox回归分析显示，eGFR水平每升高5 mL/（min·1.73 m2），中青年急性卒中患者的1年死亡风险降低8%（HR 0.92，95%CI 0.87～0.97，P =0.002）；与Q5组 [>92.5 mL/（mi n·1.73 m2）]相比，eGFR处于Q1组[<69.6 mL/（min·1.73 m2）]患者的1年死亡风险升高 1.40倍（HR 2.40，95%CI 1.02～5.67，P =0.045），其他eGFR水平组的1年死亡风险无显著性增加。生存分析发现，与其他eGFR水平组相比，Q1组的生存率明显下降（Q1组89.7% vs . Q2组96.8%，Q3组 94.4%，Q4组97.9%，Q5组96.1%），差异有统计学意义（P <0.001）。

结论 eGFR水平降低是中青年急性卒中患者1年死亡的独立危险因素，eGFR<69.6 mL/（min·1.73 m2）可显著增加中青年急性卒中患者的1年死亡率。

文章导读： 本文通过多中心卒中数据库，分析了中青年急性卒中患者eGFR水平与1年死亡的关系，结果不仅发现低水平eGFR可能增加死亡，还提示低水平eGFR患者的性别分布、神经功能损伤程度、卒中类型、合并症、血糖代谢异常等方面均与eGFR水平相对较高的患者存在潜在差异，为后续研究提供了可能的探索方向。

关键词: 中青年; 卒中; 肾小球滤过率估计值; 死亡率

Abstract:

Objective To investigate the relationship between estimated glomerular filtration rate (eGFR) and 1-year mortality in young and middle-aged patients with acute stroke in Xi’an.

Methods Based on the Xi'an Stroke Register database, the clinical and follow-up data of patients with acute stroke from four “AAA” hospitals in Xi’an from January to December 2015 were retrospectively analyzed. Young and middle-aged patients aged between 18 and 64 years were selected. All the subjects were divided into 5 groups (Q1-Q5) according to the quintile of eGFR, and the clinical characteristics and 1-year all-cause mortality among the 5 groups were compared. Multivariate Cox regression analysis was performed to analyze the relationship between eGFR and 1-year mortality in young and middle-aged patients with acute stroke. Kaplan-Meier survival curve analysis was used to analyze the survival of the 5 groups.

Results A total 1405 eligible patients were enrolled in this study, with a mean age of 53.9±8.0 years old and 961 males (68.4%). After adjustment for the related confounders, multivariate Cox regression analysis showed that 1-year mortality in young and middle-aged patients with acute stroke decreased by 8% per 5 mL/(min·1.73 m2) increase in eGFR (HR 0.92, 95%CI 0.87-0.97, P =0.002); compared with the Q5 group [eGFR <69.6 mL/(min·1.73 m2)], 1-year mortality increased by 1.40 times (HR 2.40, 95%CI 1.02-5.67, P =0.045) in Q1 group [<69.6 mL/(min·1.73 m2)], while there was no significant increase in 1-year mortality in other 3 groups. Kaplan-Meier survival analysis found a significant decrease in survival rate in the Q1 group compared to the other groups (Q1: 89.7% vs . Q2: 96.8%, Q3: 94.4%, Q4: 97.9%, Q5: 96.1%), all with statistical differences (P <0.001).

Conclusions Decreased eGFR level is an independent risk factor for 1-year mortality in young and middle-aged patients with acute stroke, and eGFR <69.6 mL/(min·1.73 m2) was associated with an obvious increase in 1-year mortality.

Key words: Young and middle-aged; Stroke; Estimated glomerular filtration rate; Mortality

张瑜瑜, 刘仲仲, 逯青丽, 王静, 刘佩, 侯丽娜, 张娜, 蔺雪梅, 王芳, 吴松笛. 西安地区中青年急性卒中患者肾小球滤过率估计值与1年死亡的关系研究[J]. 中国卒中杂志, 2022, 17(01): 73-79.

ZHANG Yuyu, LIU Zhongzhong, LU Qingli, WANG Jing, LIU Pei, HOU Lina, ZHANG Na, LIN Xuemei, WANG Fang, WU Songdi. The Relationship between eGFR and 1-Year Mortality in Young and Middle-aged Patients with Acute Stroke in Xi’an[J]. Chinese Journal of Stroke, 2022, 17(01): 73-79.

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