| 血管紧张素受体阻滞剂对急性缺血性脑卒中后并发急性肾损伤的影响 |
| 投稿时间：2024-11-18 修订日期：2024-11-27 点此下载全文 |
| 引用本文：张盼,陈大伟,万辛.血管紧张素受体阻滞剂对急性缺血性脑卒中后并发急性肾损伤的影响[J].医学研究杂志,2025,54(5):141-147 |
| DOI：
10.11969/j.issn.1673-548X.2025.05.026 |
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| 基金项目:江苏省南京市卫生科技发展专项(ZKX22035) |
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| 中文摘要:目的 探讨血管紧张素受体阻滞剂(angiotensin receptor blocker, ARB)对急性缺血性脑卒中后并发急性肾损伤(acute kidney injury, AKI)的影响。方法 收集2022年1月~2023年7月于南京市第一医院神经内科住院的急性缺血性脑卒中患者,采用1∶1倾向评分匹配法评估ARB对急性缺血性脑卒中患者并发AKI的影响。结果 根据入组与排除标准,共919例患者纳入研究,其中182例患者发生AKI,AKI发生率为19.8%。与未发生AKI的患者比较,发生AKI的患者年龄较大,高血压病、糖尿病、冠心病、心力衰竭的比例更高,入院时格拉斯哥昏迷评分(Glasgow coma scale, GCS)更低、美国国立卫生研究院卒中量表评分(National Institute of Health Stroke Scale, NIHSS)更高。在实验室检查数据方面,发生AKI的患者白细胞计数、血肌酐值更高,血红蛋白、白蛋白、低密度脂蛋白、总胆固醇更低。此外,发生AKI的患者进行血管内治疗、使用利尿剂、使用甘露醇的比例更高。倾向评分匹配后,使用ARB的患者较未使用ARB的患者AKI发生率更低(17.1% vs 25.0%, P=0.044)、病死率更低(1.2% vs 5.8%, P=0.014),而两组患者在需要肾脏替代治疗、进入重症监护室、住院天数方面比较,差异无统计学意义。结论ARB可能对急性缺血性脑卒中后AKI的发生具有潜在的保护作用。 |
| 中文关键词:急性肾损伤 急性缺血性脑卒中 血管紧张素受体阻滞剂 倾向评分匹配 |
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| Effect of Angiotensin Receptor Blocker on Acute Kidney Injury after Acute Ischemic Stroke |
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| Abstract:Objective To investigate the effect of angiotensin receptor blocker (ARB) on the occurrence of acute kidney injury (AKI) after acute ischemic stroke. Methods From January 2022 to July 2023, patients with acute ischemic stroke hospitalized in the department of neurology of Nanjing First Hospital were enrolled. A 1∶1 propensity score matching method was adopted to evaluate the effect of ARB on the occurrence of AKI in patients with acute ischemic stroke. Results According to the inclusion and exclusion criteria, 919 patients were enrolled, among whom 182developed AKI, with an incidence rate of 19.8%. Compared with patients without AKI, those with AKI were older and had a higher proportion of hypertension, diabetes, coronary heart disease, and heart failure. They were admitted with lower Glasgow coma scale (GCS) score and higher National Institute of Health Stroke Scale (NIHSS) score. In terms of laboratory test data, patients with AKI had higher white blood cell counts, serum creatinine, and lower hemoglobin, albumin, low-density lipoprotein, and total cholesterol. Additionally, patients with AKI underwent a higher proportion of endovascular treatments, used diuretics, and received mannitol. After matching propensity score, patients using ARB had a lower incidence of AKI (17.1% vs 25.0%, P=0.044) and a lower mortality rate (1.2% vs 5.8%, P=0.014) than those without ARB. There were no significant differences between the two groups in terms of renal replacement therapy, intensive care unit, and the length of hospital stay. Conclusion ARB may have a potential protective effect on the occurrence of AKI after acute ischemic stroke. |
| keywords:Acute kidney injury Acute ischemic stroke Angiotensin receptor blocker Propensity score matching |
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