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目的探讨脑卒中合并慢性肾脏病患者血清C-反应蛋白(CRP)水平的情况及其与病情严重程度和死亡率的关系。方法回顾性分析2007年5月至2008年4月本院神经内科收治的具有完整资料的患者197例,观察患者肾功能、尿常规、CRP、头颅CT或MRI、神经功能评分等指标,参照NKF-K/DOQI指南标准来定义CKD,以简化MDRD公式计算估计肾小球滤过率(eGFR)。结果①197例脑卒中患者中合并慢性肾脏病(CKD)为52例,占26.40%;②脑卒中患者中,CKD组与非CKD组CRP值分别为16.68±26.18、6.49±13.19,二组比较差异有统计学意义(t=2.688,P<0.05);CKD组CRP阳性率为67.31%,而非CKD组为42.07%,二组比较差异有统计学意义(χ2=9.758,P=0.002);③脑卒中患者中,CKD组与非CKD组神经功能评分(NIHSS)分别为7.94±7.11、5.57±4.57,二组比较差异有统计学意义(t=2.249,P<0.05);CRP阳性组与CRP阴性组神经功能评分(NIHSS)分别为7.06±5.98、5.37±4.77,二组比较差异有统计学意义(t=2.196,P<0.05);④脑卒中患者中,CKD组死亡率为9.62%,而非CKD组为0%,二组比较差异有统计学意义(χ2=10.682,P=0.001),死亡患者CRP值为59.05±40.17,明显高于存活患者CRP值(7.89±15.31),差异有统计学意义(t=2.843,P<0.05)。结论新发脑卒中患者合并CKD患者普遍存在微炎症反应,微炎症反应可能是慢性肾脏病导致脑卒中病情重、死亡率高的原因之一,CRP可视为预测CKD合并脑卒中患者病情严重程度、死亡预测的重要指标之一。
Objective To investigate the serum level of C-reactive protein (CRP) in stroke patients with chronic kidney disease and its relationship with the severity of illness and mortality. Methods A total of 197 patients with complete data were retrospectively analyzed from May 2007 to April 2008 in our hospital. The renal function, urine routine, CRP, cranial CT or MRI, neurological function score and other indexes were observed. According to NKF -K / DOQI guidelines to define CKD to simplify the MDRD formula for calculating estimated glomerular filtration rate (eGFR). Results ① There were 52 cases (26.40%) with chronic kidney disease (CKD) in 197 cases of stroke; ② The CRP of CKD group and non-CKD group were 16.68 ± 26.18,6.49 ± 13.19 respectively in stroke group (T = 2.688, P <0.05). The positive rate of CRP in CKD group was 67.31%, while it was 42.07% in non-CKD group (χ2 = 9.758, P = 0.002); ③The difference was statistically significant Neurological deficit scores (NIHSS) in CKD group and non-CKD group were 7.94 ± 7.11 and 5.57 ± 4.57 respectively in stroke patients, with significant difference between the two groups (t = 2.249, P <0.05) Negative control group (NIHSS) were 7.06 ± 5.98,5.37 ± 4.77 respectively, the difference between the two groups was statistically significant (t = 2.196, P <0.05); ④The death rate in CKD group was 9.62% (Χ2 = 10.682, P = 0.001). The CRP of death patients was 59.05 ± 40.17, which was significantly higher than that of survivors (7.89 ± 15.31), the difference was statistically significant Statistical significance (t = 2.843, P <0.05). Conclusions Microinflammatory reaction is common in patients with newly diagnosed stroke and CKD. Microinflammatory response may be one of the causes of severe stroke and death due to chronic kidney disease. CRP can be used to predict the severity of stroke in CKD patients , One of the important indicators of death prediction.