Chronic kidney disease and poor outcomes in ischemic stroke: is impaired cerebral autoregulation the missing link?
Chronic kidney disease and poor outcomes in ischemic stroke: is impaired cerebral autoregulation the missing link?
复制标题
DOI：
10.1186/s12883-018-1025-4
复制
发表时间：
2018-03-02
期刊：
影响因子：
2.6
通讯作者：
Serrador JM
中科院分区：
文献类型：
--
作者：
Castro P;Azevedo E;Rocha I;Sorond F;Serrador JM
慢性肾脏疾病会增加中风的发生率和严重程度，但这种脑-肾相互作用背后的机制大多尚不清楚。由于两个血管床具有相似的特征，微血管功能障碍可能是缺失的一环。因此，我们研究了缺血后早期肾功能和脑自我调节之间的关系及其对预后的影响。我们登记了46例缺血性中风(大脑中动脉)。通过自发性血压波动到血流速度的传递函数(相干性、相位性和增益)来评估发病6h内的动态脑自动调节。计算估计肾小球滤过率(EGFR)。分别于发病时和发病后24小时行CT扫描，收集出血性病变(HT)和脑白质病变(WML)，3个月后用改良Rankin评分评价预后。高增益(自动调节效果较差)与较低的EGFR值相关，与梗死侧无关(p <； 0.05)。低EGFR和高增益均与WML分级相关(p <； 0.0 5)。较低的EGF值和较高的增益，单独和联合使用，逐渐降低良好功能结局的几率[同侧OR = 4.39(CI95%3.15-25.6)，p = 0.019；对侧OR = 8.15(CI95%4.15-15.6)，p = 0.002]和增加高血压的风险[同侧OR = 3.48(CI95%0.60-24.0)，p = 0.132；对侧OR = 6.43(CI95%1.40-32.1)，p = 0.034]。急性缺血性卒中患者肾功能降低与动态脑自动调节功能低下相关，两者都预示着不良预后。对肾功能不全的血清生物标志物的评估可能对未来评估脑微血管风险以及与中风并发症的关系有意义。本文的在线版本(10.1186/s12883-0181025-4)包含向授权用户提供的补充材料。
Chronic kidney disease increases stroke incidence and severity but the mechanisms behind this cerebro-renal interaction are mostly unexplored. Since both vascular beds share similar features, microvascular dysfunction could be the possible missing link. Therefore, we examined the relationship between renal function and cerebral autoregulation in the early hours post ischemia and its impact on outcome. We enrolled 46 ischemic strokes (middle cerebral artery). Dynamic cerebral autoregulation was assessed by transfer function (coherence, phase and gain) of spontaneous blood pressure oscillations to blood flow velocity within 6 h from symptom-onset. Estimated glomerular filtration rate (eGFR) was calculated. Hemorrhagic transformation (HT) and white matter lesions (WML) were collected from computed tomography performed at presentation and 24 h. Outcome was evaluated with modified Rankin Scale at 3 months. High gain (less effective autoregulation) was correlated with lower eGFR irrespective of infarct side (p < 0.05). Both lower eGFR and higher gain correlated with WML grade (p < 0.05). Lower eGFR and increased gain, alone and in combination, progressively reduced the odds of a good functional outcome [ipsilateral OR = 4.39 (CI95% 3.15–25.6), p = 0.019; contralateral OR = 8.15 (CI95% 4.15–15.6), p = 0.002] and increased risk of HT [ipsilateral OR = 3.48 (CI95% 0.60–24.0), p = 0.132; contralateral OR = 6.43 (CI95% 1.40–32.1), p = 0.034]. Lower renal function correlates with less effective dynamic cerebral autoregulation in acute ischemic stroke, both predicting a bad outcome. The evaluation of serum biomarkers of renal dysfunction could have interest in the future for assessing cerebral microvascular risk and relationship with stroke complications. The online version of this article (10.1186/s12883-018-1025-4) contains supplementary material, which is available to authorized users.
登录
查看更多内容
影响因子：
19.6
作者：
Churchill, PC;Churchill, MC;Bidani, AK
通讯作者：
Bidani, AK
影响因子：
8.3
作者：
AASLID, R;LINDEGAARD, KF;NORNES, H
通讯作者：
NORNES, H
影响因子：
8.3
作者：
Fiorelli, M;Bastianello, S;Bozzao, L
通讯作者：
Bozzao, L
影响因子：
9.9
作者：
FAZEKAS, F;KLEINERT, R;LECHNER, H
通讯作者：
LECHNER, H
影响因子：
8.3
作者：
O'Rourke, MF;Safar, ME
通讯作者：
Safar, ME