Glomerular Filtration Rate is Associated with Hemorrhagic Transformation in Acute Ischemic Stroke Patients without Thrombolytic Therapy

: 肾小球滤过率与非溶栓性急性缺血性卒中患者出血转化的发生有关摘要背景：肾小球滤过率是否与急性缺血性卒中患者出血转化的发生存在关联至今尚不清楚，本研究的目的是探究肾小球滤过率水平是否是非溶栓性急性缺血性卒中患者出血转化发生的预测因素。 方法：本研究回顾性分析2014年1月至2016年12月重庆医科大学第一附属医院收治的非溶栓性缺血性卒中患者。我们将纳入人群分为两组（出血转化组与非出血转化组），并详细的收集其基本信息、实验室指标及影像学资料。采用多元回归模型分析肾小球滤过率与非溶栓性缺血性卒中患者出血性转化发生的关系。 结果：426例纳入的患者中共74例（17.3%）在影像学随访中出现出血转化（平均年龄65±12岁，男性47例）。在多元回归分析中非溶栓性缺血性卒中患者出血转化与低肾小球滤过率（OR=3.708, CI=1.326~10.693，P=0.013），房颤（OR=2.444, CI=1.087~5.356，P =0.027），大面积脑梗死（OR=2.583, CI=1.236~5.262，P =0.010）及低蛋白血症（OR=4.814, CI=1.054~22.153，P =0.037）存在显著相关性。 结论：本研究显示低肾小球滤过率是出血转化的独立预测因素，另外大面积脑梗死、房颤及低蛋白血症也均是非溶栓性缺血性卒中患者出血转化的重要危险因素。尽管本研究证据水平略显不高，但提出的一些有关于出血转化应当注意和消除的危险因素为预防卒中患者血转化的发生提供了实用的临床依据。. Methods: Consecutive AIS patients without TT were included in this prospective study from January 2014 to December 2016 in the First Affiliated Hospital of Chongqing Medical University. We divided them into two groups (HT and non-HT group) and meticulously collected baseline characteristics and laboratory and imaging data of interested individuals. Multivariate regression analysis was performed to assess the correlation between GFR and HT in stroke patients without TT. Results: Among 426 consecutive patients, 74 (17.3%) presented HT (mean age: 65 ± 12 years, number of male patients: 47) on the follow-up scans. In multivariate regression analysis, HT was significantly associated with low GFR (odds ratio [OR] = 3.708, confidence interval [CI] = 1.326-10.693, P = 0.013), atrial fibrillation (AF; OR = 2.444, CI = 1.087-5.356, P = 0.027), large cerebral infarction (OR = 2.583, CI = 1.236-5.262, P = 0.010), and hypoalbuminemia (HA; OR = 4.814, CI = 1.054-22.153, P = 0.037) for AIS patients without TT. Conclusions: The present study strongly showed that lower GFR is an independently predictor of HT; in addition, large infarct volume, AF, and HA are also important risks of HT for AIS patients without TT, which offered a practical information that risk factors should be paid attention or eliminated to prevent HT for stroke patients though the level of evidence seems to be unstable.