Abstract:

Objective To explore the effects of glomerular filtration rate (GFR) on the stroke incidence, stroke severity and cognitive function in acute ischemic stroke (AIS) patients. Methods AIS patients who were admitted to Department of Neurology of Dalian Friendship Hospital from August 2018 to October 2019 were included in this retrospective analysis. Inpatients with no stroke history during the same period were used as the control group. Univariate and multivariate analyses were performed to determine the independent influencing factors for ischemic stroke. According to the estimated GFR (eGFR), the ischemic stroke group was divided into normal eGFR subgroup (eGFR≥90 mL/min), mild decrease subgroup (60 mL/min≤eGFR<90 mL/min), moderate decrease subgroup (30 mL/min≤eGFR<60 mL/min) and severe decrease subgroup (15 mL/min≤eGFR<30 mL/min), and the differences in NIHSS score, cerebral infarction volume and cognitive function among the four subgroups were compared. Results 181 AIS patients and 133 controls were included. Lower eGFR, lower HDL-C, elevated systolic blood pressure, elevated HbA1c, history of diabetes, and advanced age were independent risk factors for AIS. In ischemic stroke group, 58 cases in normal eGFR subgroup, 75 cases in mild decrease subgroup, 32 cases in moderate decrease subgroup and 16 cases in severe decrease subgroup. Both NIHSS and cerebral infarct volume tended to increase with the decrease of eGFR. There was no statistical difference between moderate decrease subgroup and normal eGFR subgroup, while the NIHSS and cerebral infarction volume in moderate and severe decrease eGFR subgroups were significantly higher than those in normal eGFR subgroup. The cognitive function tended to decrease with the decrease of eGFR. There was no statistical difference in MMSE and MoCA scores between moderate decrease subgroup and normal eGFR subgroup, while the MMSE and MoCA scores in moderate and severe decrease subgroups were significantly lower than those in normal eGFR subgroup. Conclusions Low eGFR was an independent risk factor for ischemic stroke. eGFR mild decrease was not associated with stroke severity and cognitive impairment, while eGFR moderate or severe decrease were associated with neurological deficit and cognitive impairment.

Key words: Glomerular filtration rate; Renal insufficiency; Acute ischemic stroke; Vascular injury; Cognitive function

摘要：

目的 探讨肾小球滤过率对急性缺血性卒中发病、严重程度及患者认知功能的影响。 方法 回顾性分析2018年8月-2019年10月就诊于大连市友谊医院神经内科的急性缺血性卒中患 者的临床资料，以同期入院的非卒中且无卒中病史患者为对照组，对两组的基线资料进行单因 素和多因素分析，判断缺血性卒中的独立影响因素。另外，缺血性卒中组按照估算的肾小球滤过 率（estimated glomerular filtration rate，eGFR）分为eGFR正常组（eGFR≥90 mL／min）、轻度降低 组（60 mL/mi n≤eGFR＜90 mL／mi n）、中度降低组（30 mL/mi n≤eGFR＜60 mL／mi n）和重度降低组 （15 mL/min≤eGFR＜30 mL／min），比较4组患者NIHSS评分、脑梗死体积及认知功能的差异。 结果 研究共入组缺血性卒中患者181例，对照组133例。eGFR降低、HDL-C水平降低、收缩压升高、 糖化血红蛋白水平升高、糖尿病病史及年龄增加是急性缺血性卒中的独立危险因素。在缺血性卒中 患者中，eGFR正常组、轻度降低组、中度降低组和重度降低组分别为58例、75例、32例和16例，NIHSS 及脑梗死体积均有随着eGFR降低而增加的趋势，其中，eGFR轻度降低组与正常组的NIHSS和脑梗死 体积差异无统计学意义，但中、重度eGFR降低组的NIHSS和脑梗死体积均显著高于正常eGFR组。另外， 缺血性卒中患者的认知功能水平也有随着eGFR下降而降低的趋势，其中eGFR轻度降低组与正常组 的MMSE和MoCA评分差异无统计学意义，但中、重度eGFR降低组的MMSE和MoCA评分均显著低于正常 eGFR组。 结论 低eGFR为缺血性卒中的独立危险因素，轻度eGFR水平降低与梗死严重程度及认知功能损害 无关，而eGFR中、重度降低与缺血性卒中神经功能缺损及认知功能损害有关。

关键词: 肾小球滤过率; 肾功能不全; 缺血性卒中; 血管损伤; 认知功能