Correlation between changes of brain microbleed and worsening of chronic kidney disease in patients with lacunar infarction / 中国医师进修杂志

ABSTRACT

Objective To investigate the correlation between the progression of cerebral microbleed (CMB) and their distribution patterns in patients with lacunar infarction (LI) and the worsening of chronic kidney disease (CKD).Methods A prospective cohort study was used.Two hundred and fourteen patients with LI from June 2014 to June 2016 in Siyang People's Hospital of Jiangsu Province were consecutively selected.The clinical,laboratory and imaging-related data of patients were recorded in detail.The chronic kidney disease epidemiology collaboration (CKD-EPI) formula was used to estimate the estimation glomerular filtration rate (eGFR).After admission and 1-year'follow-up,head MRI (including gradient echo sequences) was performed,and the CMB distribution pattern was evaluated using the microbleed anatomical rating scale (MARS).Results Among the 214 patients with LI,90 patients were in CMB-positive group,of which simple lobe of brain CMB was in 16 cases,and deep/subtentorial CMB was in 74 cases,and 124 patients were in CMB-negative group.The baseline eGFR and eGFR classifications in CMB-negative group were significantly better than those in CMB-positive group,and there were statistical differences (P＜0.01 or ＜0.05).After 1 year'follow-up,worsening of CMB was in 45 cases,and worsening of CKD was in 22 cases.Multivariate Logistic regression analysis result showed that age and stroke history were independent risk factors for worsening of CMB in LI patients with simple lobe of brain CMB (OR =1.14 and 2.91,95％ CI 1.06 to 1.23 and 1.14 to 7.42,P＜0.01 or ＜0.05),and baseline eGFR and worsening of CKD were independent risk factors for worsening of CMB in LI patients with deep/subtentorial CMB (OR =0.90 and 4.11,95％ CI 0.87 to 0.94 and 1.04 to 16.21,P＜0.01 or ＜0.05).Conclusions Renal function in LI patients with CMB negative is significantly better than that in LI patients with CMB positive.In LI patients with deep/subtentorial CMB,the worsening of CMB is associated with worsening of CKD;in LI patients with simple lobe of brain CMB,the worsening of CMB is not associated with worsening of CKD.