急性脑卒中后发生急性肾损伤危险因素分析
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摘要
[目的]调查急性脑卒中后发生急性肾损伤的危险因素。[方法]回顾性分析2016年1月—2018年1月我院218例急性脑卒中病人。收集病人入院时的临床资料,运用改良Rankin量表(mRS)评估病人急性脑卒中后身体功能恢复情况,采用美国国立卫生研究院脑卒中量表(NIHSS)评估病人临床症状的严重程度。[结果]急性肾损伤组43例,无急性肾损伤组175例。两组NIHSS评分、脑卒中严重程度、尿素氮、肌酐、估计肾小球滤过率(eGFR)基线值、肾替代治疗(RRT)比例、住院死亡率、住院时间比较差异均有统计学意义(P<0.05),且急性肾损伤组的高血压和肾功能不全病史比例均显著高于无急性肾损伤组(P<0.01),造影剂使用比例显著低于无急性肾损伤组(P<0.01)。多因素分析结果显示,较高的NIHSS评分、较低的eGFR基线、高血压、肾功能不全是急性脑卒中后发生急性肾损伤的独立危险因素。[结论]护理工作中应及时发现具有较高的NIHSS评分、较低的eGFR基线值、高血压和肾功能不全等急性肾损伤高风险病人,并给予适当的监测和干预。
Objective:To investigate the risk factors of acute kidney injury(AKI) patients after acute stroke.Methods:A total of 218 patients with acute stroke who met the inclusion and exclusion criteria from January 2016 to January 2018 were analyzed retrospectively.Clinical parameters including age,sex,body mass index(BMI),Glasgow Coma Scale(GCS),acute stroke type were collected.The improved Rankin Scale(mRS)was used to evaluate the recovery of body function after acute stroke.The severity of clinical symptoms was assessed according to the National Institutes of Health Stroke Scale(NIHSS).Results:There were 43 patients in AKI group and 175 patients in non-AKI group.There were statistically significant differences between the two groups in terms of NIHSS score,stroke severity,BUN,Cr,eGFR baseline,renal replacement therapy(RRT)ratio,in-hospital mortality,and length of hospital stay(P<0.05).And the proportion of hypertension and renal insufficiency in the AKI group was significantly higher than that in the non-AKI group(P<0.01).And the proportion of contrast agent was significantly lower than that in the non-AKI group(P<0.01).Multivariate analysis showed that the higher NIHSS scores,the lower eGFR baseline,hypertension,and renal insufficiency were independent risk factors for acute kidney injury after acute stroke.Conclusions:The higher NIHSS scores,the lower eGFR baseline values,hypertension and renal insufficiency are independent risk factors for AKI in patients with acute stroke.Patients with high risk of AKI must be found in time in nursing work,so as to carry out appropriate monitoring and intervention.
Objective:To investigate the risk factors of acute kidney injury(AKI) patients after acute stroke.Methods:A total of 218 patients with acute stroke who met the inclusion and exclusion criteria from January 2016 to January 2018 were analyzed retrospectively.Clinical parameters including age,sex,body mass index(BMI),Glasgow Coma Scale(GCS),acute stroke type were collected.The improved Rankin Scale(mRS)was used to evaluate the recovery of body function after acute stroke.The severity of clinical symptoms was assessed according to the National Institutes of Health Stroke Scale(NIHSS).Results:There were 43 patients in AKI group and 175 patients in non-AKI group.There were statistically significant differences between the two groups in terms of NIHSS score,stroke severity,BUN,Cr,eGFR baseline,renal replacement therapy(RRT)ratio,in-hospital mortality,and length of hospital stay(P<0.05).And the proportion of hypertension and renal insufficiency in the AKI group was significantly higher than that in the non-AKI group(P<0.01).And the proportion of contrast agent was significantly lower than that in the non-AKI group(P<0.01).Multivariate analysis showed that the higher NIHSS scores,the lower eGFR baseline,hypertension,and renal insufficiency were independent risk factors for acute kidney injury after acute stroke.Conclusions:The higher NIHSS scores,the lower eGFR baseline values,hypertension and renal insufficiency are independent risk factors for AKI in patients with acute stroke.Patients with high risk of AKI must be found in time in nursing work,so as to carry out appropriate monitoring and intervention.
引文
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[13] ZORRILLA-VACA A,ZIAI W,CONNOLLY E S,et al.Acute kidney injury following acute ischemic stroke and intracerebral hemorrhage:a meta-analysis of prevalence rate and mortality risk[J].Cerebrovasc Dis,2018,45(1/2):1-9.
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[15] DOYLE J F,FORNI L G.Acute kidney injury:short-term and long-term effects[J].Crit Care,2016,20(1):188.
[16] CHEN Y,JIN S,TENG X,et al.Hydrogen sulfide attenuates LPS-induced acute kidney injury by inhibiting inflammation and oxidative stress[J].Oxid Med Cell Longev,2018,67(17):212-214.
[17] HORNE K L,PACKINGTON R,MONAGHAN J,et al.Three-year outcomes after acute kidney injury:results of a prospective parallel group cohort study[J].BMJ Open,2017,7(3):e015316.
[18] JAMES M T,GRAMS M E,WOODWARD M,et al.A meta-analysis of the association of estimated GFR,albuminuria,diabetes mellitus,and hypertension with acute kidney injury[J].Am J Kidney Dis,2015,66(4):602-612.
[19] TZIOMALOS K,GEORGARAK I M,BOUZIANA S D,et al.Impaired kidney function evaluated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is associated with more severe acute ischemic stroke[J].Vasc Med,2017,22(5):432-434.
[20] GADALEAN F,SIMU M,PARV F,et al.The impact of acute kidney injury on in-hospital mortality in acute ischemic stroke patients undergoing intravenous thrombolysis[J].PLoS One,2017,12(10):e0185589.
[21] BURGESS L G,GOYAL N,JONES G M,et al.Evaluation of acute kidney injury and mortality after intensive blood pressure control in patients with intracerebral hemorrhage[J].J Am Heart Assoc,2018,7(8):e008439.
[22] HEWGLEY H,TURNER S C,VANDIGO J E,et al.Impact of admission hypertension on rates of acute kidney injury in intracerebral hemorrhage treated with intensive blood pressure control[J].Neurocrit Care,2018,28(3):344-352.
[23] ZHENG D,SATO S,ARIMA H,et al.INTERACT2 investigators estimated GFR and the effect of intensive blood pressure lowering after acute intracerebral hemorrhage[J].Am J Kidney Dis,2016,68(1):94-102.
[24] WANG D,GUO Y,ZHANG Y,et al.Epidemiology of acute kidney injury in patients with stroke:a retrospective analysis from the neurology ICU[J].Intern Emerg Med,2018,13(1):17-25.
[25] SNARSKA K,KAPICA-TOPCZEWSKA K,BACHORZEWSKA-GAJEWSKA H,et al.Renal function predicts outcomes in patients with ischaemic stroke and haemorrhagic stroke[J].Kidney Blood Press Res,2016,41(4):424-433.
[2] SAEED F,ADIL M M,PIRACHA B H,et al.Acute renal failure worsens in-hospital outcomes in patients with intracerebral hemorrhage[J].J Stroke Cerebrovasc Dis,2015,24:789-794.
[3] CASTRO P,AZEVEDO E,ROCHA I,et al.Chronic kidney disease and poor outcomes in ischemic stroke:is impaired cerebral autoregulation the missing link?[J].BMC Neurol,2018,18(1):21.
[4] EL HUSSEINI N,FONAROW G C,SMITH E E,et al.Renal dysfunction is associated with poststroke discharge disposition and in-hospital mortality:findings from get with the guidelines-stroke[J].Stroke,2017,48(2):327-334.
[5] BRINJIKJI W,DEMCHUK A M,MURAD M H,et al.Neurons over nephrons:systematic review and meta-analysis of contrast-induced nephropathy in patients with acute stroke[J].Stroke,2017,48(7):1862-1868.
[6] LIN S Y,TANG S C,TSAI L K,et al.Incidence and risk factors for acute kidney injury following mannitol infusion in patients with acute stroke:a retrospective cohort study[J].Medicine(Baltimore),2015,94(47):e2032.
[7] TELES F,DE MENDON?A UCH?A J V.Acute kidney injury in leptospirosis:the Kidney Disease Improving Global Outcomes (KDIGO) criteria and mortality[J].Clin Nephrol,2016,86(12):303-309.
[8] DIAZ-OTERO J M,FISHER C,DOWNS K,et al.Endothelial mineralocorticoid receptor mediates parenchymal arteriole and posterior cerebral artery remodeling during angiotensin Ⅱ-induced hypertension[J].Hypertension,2017,70(6):1113-1121.
[9] WU V C,WU P C,WU C H,et al.The impact of acute kidney injury on the long-term risk of stroke[J].J Am Heart Assoc,2014,3(4):e000933.
[10] KHATRI M,HIMMELFARB J,ADAMS D,et al.Acute kidney injury is associated with increased hospital mortality after stroke[J].J Stroke Cerebrovasc Dis,2014,23(1):25-30.
[11] COVIC A,SCHILLER A,MARDARE N G,et al.The impact of acute kidney injury on short-term survival in an Eastern European population with stroke[J].Nephrol Dial Transplant,2008,23(7):2228-2234.
[12] SAEED F,ADIL M M,KHURSHEED F,et al.Acute renal failure is associated with higher death and disability in patients with acute ischemic stroke:analysis of nationwide inpatient sample[J].Stroke,2014,45(5):1478-1480.
[13] ZORRILLA-VACA A,ZIAI W,CONNOLLY E S,et al.Acute kidney injury following acute ischemic stroke and intracerebral hemorrhage:a meta-analysis of prevalence rate and mortality risk[J].Cerebrovasc Dis,2018,45(1/2):1-9.
[14] HSIA C C W,RAVIKUMAR P,YE J,et al.Acute lung injury complicating acute kidney injury:a model of endogenous αKlotho deficiency and distant organ dysfunction[J].Bone,2017,100:100-109.
[15] DOYLE J F,FORNI L G.Acute kidney injury:short-term and long-term effects[J].Crit Care,2016,20(1):188.
[16] CHEN Y,JIN S,TENG X,et al.Hydrogen sulfide attenuates LPS-induced acute kidney injury by inhibiting inflammation and oxidative stress[J].Oxid Med Cell Longev,2018,67(17):212-214.
[17] HORNE K L,PACKINGTON R,MONAGHAN J,et al.Three-year outcomes after acute kidney injury:results of a prospective parallel group cohort study[J].BMJ Open,2017,7(3):e015316.
[18] JAMES M T,GRAMS M E,WOODWARD M,et al.A meta-analysis of the association of estimated GFR,albuminuria,diabetes mellitus,and hypertension with acute kidney injury[J].Am J Kidney Dis,2015,66(4):602-612.
[19] TZIOMALOS K,GEORGARAK I M,BOUZIANA S D,et al.Impaired kidney function evaluated with the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is associated with more severe acute ischemic stroke[J].Vasc Med,2017,22(5):432-434.
[20] GADALEAN F,SIMU M,PARV F,et al.The impact of acute kidney injury on in-hospital mortality in acute ischemic stroke patients undergoing intravenous thrombolysis[J].PLoS One,2017,12(10):e0185589.
[21] BURGESS L G,GOYAL N,JONES G M,et al.Evaluation of acute kidney injury and mortality after intensive blood pressure control in patients with intracerebral hemorrhage[J].J Am Heart Assoc,2018,7(8):e008439.
[22] HEWGLEY H,TURNER S C,VANDIGO J E,et al.Impact of admission hypertension on rates of acute kidney injury in intracerebral hemorrhage treated with intensive blood pressure control[J].Neurocrit Care,2018,28(3):344-352.
[23] ZHENG D,SATO S,ARIMA H,et al.INTERACT2 investigators estimated GFR and the effect of intensive blood pressure lowering after acute intracerebral hemorrhage[J].Am J Kidney Dis,2016,68(1):94-102.
[24] WANG D,GUO Y,ZHANG Y,et al.Epidemiology of acute kidney injury in patients with stroke:a retrospective analysis from the neurology ICU[J].Intern Emerg Med,2018,13(1):17-25.
[25] SNARSKA K,KAPICA-TOPCZEWSKA K,BACHORZEWSKA-GAJEWSKA H,et al.Renal function predicts outcomes in patients with ischaemic stroke and haemorrhagic stroke[J].Kidney Blood Press Res,2016,41(4):424-433.