Renal Dysfunction Associated with Symptomatic Intracranial Hemorrhage after Intravenous Thrombolysis
Renal Dysfunction Associated with Symptomatic Intracranial Hemorrhage after Intravenous Thrombolysis
复制标题
静脉溶栓后与症状性颅内出血相关的肾功能障碍
DOI：
10.1016/j.jstrokecerebrovasdis.2019.104363
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发表时间：
2019-11-01
影响因子：
2.5
通讯作者：
Cai, Xiuying
中科院分区：
文献类型：
--
作者：
Zhu, Juehua;Shen, Xiahong;Cai, Xiuying
背景和目的：肾功能不全（RD）在需要静脉溶栓的急性缺血性卒中患者中很常见。根据先前的研究，肾功能与溶栓相关颅内出血（ICH）并发症之间的关系是矛盾的。本研究旨在阐明急性缺血性卒中患者接受重组组织型纤溶酶原激活剂（IV rtPA）治疗后，RD是否会增加症状性颅内出血（SICH）的风险。研究方法：在这项观察性研究中，回顾性分析了在症状发作后4.5小时内接受IV rtPA治疗的急性缺血性卒中患者。入院时肌酐水平用于计算肾小球滤过率（GFR）以估计RD。SICH的定义采用美国国家神经疾病和卒中研究所（NINDS，SICHNINDS）或欧洲急性卒中研究合作组织II（ECASS II，SICHECASS II）标准。使用连续GFR或二元GFR（RD定义为GFR < 90 ml/min/1.73 m2）评估RD与SICH的相关性。结果：312例患者中，SICHNINDS发生率为7.69%，SICHECASSII发生率为5.45%。RD患者的SICHNINDS患病率较高（12.80%对2.03%，P <0.001），SICHECASS II患病率较高（9.15%对1.35%，P = 0.002）。GFR作为一个连续变量与SICHNINDS相关（OR调整= 0.97，P = 0.003），但与SICHECASS II无关。在多元逻辑回归分析中，GFR小于90 ml/min/1.73 m2与SICHNINDS（OR调整= 4.79，P = 0.016）和SICHECASS II（OR调整= 2.99，P = 0.032）独立相关。结论：肾功能与IV rtPA溶栓后SICH独立相关。RD是SICHNINDS和SICHECASS II的独立预测因子。在评价IV rtPA静脉溶栓的风险时，应考虑RD。
Background and Aim: Renal dysfunction (RD) is prevalent in patients with acute ischemic stroke requiring intravenous thrombolysis. The relationship between renal function and thrombolysis related intracranial hemorrhagic (ICH) complications is contradictory according to previous studies. The current study is to clarify whether RD could increase the risk of symptomatic intracranial hemorrhage (SICH) after recombinant tissue plasminogen activator (IV rtPA) in acute ischemic stroke patients. Methods: In this observational study, acute ischemic stroke patients who received IV rtPA within 4.5 hours of symptom onset were retrospectively analyzed. Creatinine levels on admission served to calculate glomerular filtration rate (GFR) to estimate RD. SICH was defined with National Institute of Neurological Disorder and Stroke (NINDS, SICHNINDS) or European Cooperative Acute Stroke Study II (ECASS II, SICHECASSII) criteria. Association of RD with SICH was assessed using continuous GFR or binary GFR (RD defined as GFR < 90 ml/minute/1.73 m(2)). Results: Of 312 patients included, the incidence of SICHNINDS was 7.69%, of SICHECASSII was 5.45%. Patients with RD had higher prevalence of SICHNINDS (12.80% versus 2.03%, P < .001) and SICHECASS II (9.15% versus 1.35%, P = .002). GFR as a continuous variable was associated with SICHNINDS (ORadjust = .97, P = .003), but not with SICHECASS II. GFR less than 90 ml/minute/1.73 m2 remained independently associated with SICHNINDS (ORadjust = 4.79, P = .016), and SICHECASS II (ORadjust = 2.99, P = .032) in multiple logistic regression analysis. Conclusions: Renal function is independently associated with SICH after IV rtPA thrombolysis. RD is an independent predictor for both SICHNINDS and SICHECASS II. RD should be considered when evaluating the risk of intravenous thrombolysis with IV rtPA.