摘要
目的探讨急性前循环缺血性卒中患者取栓术后发生急性肾损伤(AKI)的影响因素。方法回顾性连续纳入2018年4月至2019年7月Captor取栓支架临床试验数据库(中国临床试验登记数据库,注册号:ChiCTR1900025256)中急性前循环颅内大血管闭塞取栓患者214例,接受了Captor或Solitaire FR急诊支架取栓治疗。根据取栓术后是否并发AKI,将214例患者分为AKI组(29例)和非AKI组(185例)。收集患者的基线、临床资料(实验室检查、手术、并发症)等相关资料并进行组间比较,其中基线资料包括年龄、性别、收缩压、舒张压、平均动脉压、高血压病、糖尿病、冠心病、高脂血症、心力衰竭、卒中史、心房颤动、吸烟史、入院美国国立卫生研究院卒中量表评分、入院改良Rankin量表评分、入院格拉斯哥昏迷量表评分;实验室检查包括红细胞计数、白细胞计数、血小板计数、血红蛋白、术前血糖、术前血肌酐、术前估算肾小球滤过率(eGFR);手术资料包括闭塞大血管(颈内动脉颅内段、大脑中动脉、大脑前动脉)、术前溶栓治疗、取栓次数、闭塞血管成功再通、发病至治疗时间、手术时间、药物(抗血小板聚集、抗凝、他汀类药物);术后并发症包括蛛网膜下腔出血、症状性颅内出血、脑疝等。成功再通为术后改良脑梗死溶栓(mTICI)分级2b^3级。经变量的共线性检验和变量筛选,以发生AKI为因变量,将单因素分析中P<0.1的自变量纳入多因素Logistic回归分析(向前法)。结果(1)急性缺血性卒中急诊支架取栓治疗患者AKI的发生率为13.6%(29/214)。AKI组糖尿病比例、术前血糖水平均高于非AKI组,组间差异均有统计学意义[34.5%(10/29)比12.4%(23/185),χ^2=7.732;8.4(7.3,10.3)mmol/L比7.4(6.2,8.4)mmol/L,t=-2.901;均P<0.05];余基线资料的组间差异均无统计学意义(均P>0.05)。(2)29例AKI组患者术前eGFR≥90、60~89、30~59、<30 ml/(min·1.73 m^2)者分别占37.9%(11例)、41.4%(12例)、13.8%(4例)、6.9%(2例);185例非AKI组患者术前eGFR≥90、60~89、30~59 ml/(min·1.73 m^2)者分别占44.9%(83例)、42.2%(78例)、13.0%(24例),无eGFR<30 ml/(min·1.73 m^2)者。两组患者术前eGFR分类的差异有统计学意义(H=1.116,P=0.046)。AKI组患者术后症状性颅内出血、蛛网膜下腔出血、脑疝的比例均高于非AKI组,差异均有统计学意义[24.1%(7/29)比5.9%(11/185),χ^2=8.538;31.0%(9/29)比8.6%(16/185),χ2=10.104;27.6%(8/29)比7.6%(14/185),χ^2=8.830;均P<0.05];余实验室资料、手术资料的组间差异均无统计学意义(均P>0.05)。(3)多因素Logistic回归分析显示,糖尿病(OR=3.965,95%CI:1.615~9.737,P=0.003),手术时间延长(OR=1.006,95%CI:1.000~1.012,P=0.042)是急性缺血性卒中患者取栓术后发生AKI的独立危险因素。结论糖尿病史和手术时间延长可能增加急性前循环缺血性卒中急诊机械取栓患者术后发生AKI的风险。
Objective To investigate the influencing factors for acute kidney injury(AKI)after thrombectomy in patients with acute anterior circulation ischemic stroke.Methods From April 2018 to July 2019,214 patients with acute anterior circulation large vessel occlusion of the Captor Stent Retriever Clinical Trial Database(Chinese Clinical Trial Registration Database,No.ChiCTR1900025256)were consecutively enrolled.Patients received thrombectomy with Captor or Solitaire FR stents.Patients were divided into the AKI group(29 cases)and the non-AKI group(185 cases)according to the occurrence of AKI after thrombectomy.Baseline and clinical data(laboratory tests,operation,complications,etc.)of patients were collected and compared between groups.Baseline data included age,gender,systolic blood pressure,diastolic blood pressure,mean arterial pressure,hypertension,diabetes,coronary heart disease,hyperlipidemia,heart failure,stroke history,atrial fibrillation,smoking history,the National Institutes of Health Stroke Scale score on admission,modified Rankin Scale(mRS)score on admission and Glasgow Coma Scale(GCS)on admission.Laboratory data included red blood cell count,white blood cell count,platelet count,hemoglobin,preoperative blood glucose,preoperative serum creatinine,and preoperative estimated glomerular filtration rate(eGFR).Operative data included occlusion large vessel(intracranial internal carotid artery,middle cerebral artery and anterior cerebral artery),preoperative intravenous thrombolysis,retrieval attempts,successful recanalization,time from symptom onset to treatment,operative time,and medication(antiplatelet drugs,anticoagulants and statins).Postoperative complications included subarachnoid hemorrhage,symptomatic intracranial hemorrhage and brain herniation etc..Successful recanalization was graded as modified cerebral infarction thrombolysis(mTICI)grade 2b-3.Collinearity test and variable selection were performed.With AKI as the dependent variable,all variables with P<0.1 in univariate analysis were included in multivariate logistic regression analysis(forward).Results(1)The incidence of AKI after thrombectomy in patients with acute ischemic stroke was 13.6%(29/214).The proportion of diabetes and preoperative blood glucose were significantly higher in AKI group than in non-AKI group(34.5%[10/29]vs.12.4%[23/185],χ^2=7.732;8.4[7.3,10.3]mmol/L vs.7.4[6.2,8.4]mmol/L,t=-2.901;both P<0.05).There were no statistically significant differences in the remaining baseline data between two groups(all P>0.05).(2)In the AKI group,patients with eGFR≥90 ml/(min·1.73 m^2),eGFR 60-89 ml/(min·1.73 m^2),eGFR 30-59 ml/(min·1.73 m^2),and eGFR<30 ml/(min·1.73 m^2)accounted for 37.9%(11 cases),41.4%(12 cases),13.8%(4 cases)and 6.9%(2 cases)in 29 patients,respectively.In the non-AKI group,patients with eGFR≥90 ml/(min·1.73 m^2),eGFR 60-89 ml/(min·1.73 m^2),eGFR 30-59 ml/(min·1.73 m^2),and eGFR<30 ml/(min·1.73 m^2)accounted for 44.9%(83 cases),42.2%(78 cases),13.0%(24 cases),and 0 case in 185 patients,respectively.Differences of categorically preoperative eGFR in two groups were statistically significant(H=1.116,P=0.046).The proportion of postoperative symptomatic intracranial hemorrhage,subarachnoid hemorrhage and brain herniation were significantly higher in AKI group than in non-AKI group(24.1%[7/29]vs.5.9%[11/185],χ^2=8.538;31.0%[9/29]vs.8.6%[16/185],χ^2=10.104;27.6%[8/29]vs.7.6%[14/185],χ^2=8.830;all P<0.05).There were no significant differences in the remaining laboratory and operative data(all P>0.05).(3)Multivariate logistic regression analysis showed that diabetes(OR,3.965,95%CI 1.615-9.737,P=0.003)and longer operation time(OR,1.006,95%CI 1.000-1.012,P=0.042)were independent risk factors for AKI after thrombectomy in patients with acute ischemic stroke.Conclusion Diabetes and longer operation time may increase the risk of AKI after mechanical thrombectomy in patients with acute anterior circulation ischemic stroke.
作者
杨晴雯
查明明
黄抗默
蔡浩荻
吕秋石
刘锐
刘新峰
Yang Qingwen;Zha Mingming;Huang Kangmo;Cai Haodi;Lyu Qiushi;Liu Rui;Liu Xinfeng(Department of Neurology,the Second Clinical College of Southeast University School of Medicine(General Hospital of Eastern War Zone),Nanjing 210002,China;不详)
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2020年第12期713-719,共7页
Chinese Journal of Cerebrovascular Diseases
基金
国家自然科学基金青年科学基金项目(81701229、81701299、81901218)。
关键词
急性缺血性卒中
机械取栓
急性肾损伤
影响因素
Acute ischemic stroke
Mechanical thrombectomy
Acute kidney injury
Influencing factor
