【摘要】：目的： 評估急性腎損傷對高血壓合并出血性腦卒中患者近期預(yù)后的影響。 方法： 收集2005年1月1日至2012年6月1日在太原市中心醫(yī)院診治且病歷資料、影像學(xué)資料完整的全部腦出血患者，共806例，全部于發(fā)病后24h內(nèi)經(jīng)頭顱CT證實腦出血，均符合《中國腦血管病防治指南》關(guān)于腦出血的診斷標(biāo)準(zhǔn)。下列病例排除在本研宄之外；未經(jīng)頭顱CT及MRI診斷者；瘤卒中等繼發(fā)腦出血者；腦外傷導(dǎo)致出血者既往合并慢性腎臟病史者；病史及診斷不明確者。急性腎損傷定義為7天內(nèi)最高肌酐水平較入院時升高50%。病人根據(jù)入院期間腎小球濾過率以及是否發(fā)生急性腎損傷分為4個亞組：eGFR90不合并急性腎損傷，eGFR90不合并急性腎損傷，eGFR90合并急性腎損傷，以及eGFR90合并急性腎損傷。 結(jié)果： 本研宄中16.7%的病人發(fā)生了急性腎損傷。入院時的腎小球濾過率不是預(yù)測患者近期發(fā)生死亡的獨立危險因素。但是，急性腎損傷與患者近期預(yù)后明顯相關(guān)。各亞組30天內(nèi)發(fā)生死亡的住院患者通過調(diào)整后的風(fēng)險比率（AHR，Cox多元回歸分析）進(jìn)行組間比較。eGFR90不伴急性腎損傷AHR1.0(95%CI0.42-1.82)，eGFR90不伴急性腎損傷AHR1.18(95%CI0.79-1.76)，eGFR90伴急性腎損傷AHR1.70(95%CI1.09-2.63)，eGFR90伴急性腎損傷AHR1.86(95%CI1.09-3.17). 結(jié)論： 無論入院時eGFR是否降低，急性腎損傷均是患者住院期間近期發(fā)生死亡的獨立危險因素.
[Abstract]:Objective: to evaluate the effect of acute renal injury on short-term prognosis of hypertensive patients with hemorrhagic stroke. Methods: medical records were collected from January 1, 2005 to June 1, 2012 in Taiyuan Central Hospital. All the 806 patients with cerebral hemorrhage with complete imaging data were confirmed by head CT within 24 hours after onset. All of them accord with the diagnostic criteria of cerebral hemorrhage in China guidelines for the Prevention and treatment of Cerebrovascular Diseases. The following cases were excluded from the study: those who had not been diagnosed by CT and MRI of the head; those with secondary intracerebral hemorrhage in the middle of the tumor stroke; those with previous chronic renal history of hemorrhage caused by brain trauma; and those whose history and diagnosis were not clear. Acute renal injury is defined as a 50% increase in creatinine within 7 days from admission. The patients were divided into 4 subgroups according to glomerular filtration rate (GFR) and acute renal injury during admission: eGFR90 without acute renal injury, eGFR90 with acute renal injury, and eGFR90 with acute renal injury. Results: acute renal injury occurred in 16.7% of the patients. Glomerular filtration rate at admission is not an independent risk factor for short-term death. However, acute renal injury was significantly associated with short-term prognosis. Patients who died within 30 days in each subgroup were compared by adjusted risk ratio (AHR,Cox multiple regression analysis). EGFR90 was not associated with acute renal injury (AHR1.0 (95%CI0.42-1.82). EGFR90 without acute renal injury AHR1.18 (95%CI0.79-1.76), eGFR90 with acute renal injury AHR1.70 (95%CI1.09-2.63), eGFR90 with acute renal injury AHR1.86 (95%CI1.09-3.17). Conclusion: acute renal injury is an independent risk factor for short-term death in patients with acute renal injury, regardless of the decrease of eGFR at admission.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R544.1;R743.3

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