中国血液净化

中国血液净化 ›› 2025, Vol. 24 ›› Issue (08): 648-652.doi: 10.3969/j.issn.1671-4091.2025.08.006

• 临床研究 • 上一篇    下一篇

终末期肾病透析患者发生脑出血的影响因素及预后

赵 媛   于世林   

  1. 101300 北京，北京市顺义区医院1神经内科 2内分泌科
  • 收稿日期:2025-01-14 修回日期:2025-05-18 出版日期:2025-08-12 发布日期:2025-08-12
  • 通讯作者: 于世林 E-mail:valentine9977@sina.com

Risk factors and prognosis of intracerebral hemorrhage in dialysis dependent ESRD patients

ZHAO Yuan, YU Shi-lin   

  1. Department of Neurology, and   2Department of Endocrinology, Beijing Shunyi District Hospital, 101300  Beijing, China
  • Received:2025-01-14 Revised:2025-05-18 Online:2025-08-12 Published:2025-08-12
  • Contact: 101300 北京，北京市顺义区医院2内分泌科 E-mail:valentine9977@sina.com

摘要： 目的 探讨终末期肾病(end stage renal disease,ESRD)透析患者发生脑出血(intracerebral hemorrhage,ICH)的影响因素及预后。 方法 回顾性收集北京市顺义区医院2021年1月—2024年1月规律维持性透析治疗的ESRD患者，根据是否并发脑出血分为脑出血组和非脑出血组，分析2组患者人口学、既往史、现病史、实验室、影像学、治疗方面等临床资料，探讨透析患者发生脑出血的影响因素。 结果 共纳入206例患者，其中脑出血组42例(20.4%)，非脑出血组164例(79.6%)。脑出血组中男性 (c2=4.323,P=0.016)、既往卒中病史(c2=7.621,P=0.000)、血液透析治疗(c2=0.294，P=0.043)、3个月内透析前平均收缩压增高(Z=3.532,P=0.030)、抗血小板药物使用(c2=4.021,P=0.026)、脑白质高信号   (c2=6.202,P=0.002)、脑微出血(c2=9.282,P＜0.000)比例高于非脑出血组；脑出血组中B型钠尿肽   (t=4.326,P=0.024)、纤维蛋白原(t=3.002,P=0.038)、血钙(t=4.234,P=0.023)、血磷(t=5.203,P=0.006)水平增高，血小板计数(t=3.469,P=0.032)和血钠(t=9.821，P＜0.000)水平减低。多因素Logistic回归分析显示卒中病史(OR=1.610,95% CI：1.021～4.320,P=0.041)、3个月内透析前平均收缩压增高(OR=2.526,95% CI：1.470～5.323,P=0.004)、血液透析治疗(OR=3.190,95% CI：1.620～6.270,P=0.007)、脑白质高信号(OR=3.521,95% CI：1.313～6.482,P=0.030)、脑微出血(OR=2.797,95% CI：1.168～6.701,    P=0.011)是影响ESRD患者并发脑出血的独立危险因素。脑出血组3个月时随访改良Rankin量表(modified Rankin scale，mRS)≤2分13例(31.0%)；mRS评分＞2分29例(69.0%)，其中4例(9.5%)死亡。 结论 ESRD患者并发脑出血风险较高，且多预后不佳。

关键词: 终末期肾病, 脑出血, 危险因素, 预后

Abstract: Objective  To explore the risk factors and prognosis of intracerebral hemorrhage (ICH)  in dialysis dependent end stage renal disease (ESRD) patients.  Methods  We retrospectively analyzed ESRD patients receiving regular maintenance dialysis at Beijing Shunyi District Hospital (January 2021-January 2024). Participants were stratified into ICH and non-ICH groups. Demographic characteristics, medical history, laboratory parameters, imaging findings, and treatment data were compared to identify ICH risk factors.  Results  Among 206 enrolled patients, 42 (20.4%) developed ICH. Compared to non-ICH controls (n=164), the ICH group showed significantly higher proportions of males χ²=4.323, P=0.016), stroke history (χ²=7.621, P=0.000), hemodialysis (vs. peritoneal dialysis; χ²=0.294, P=0.043), elevated mean pre-dialysis systolic blood pressure (SBP) within 3 months (Z=3.532, P=0.030), antiplatelet drug use (χ²=4.021, P=0.026), white matter hyperintensity (χ²=6.202, P=0.002), and cerebral microhemorrhage (χ²=9.282, P＜0.000), along with elevated B-type natriuretic peptide (t=4.326, P=0.024), fibrinogen (t=3.002, P=0.038), serum calcium (t=4.234, P=0.023), and  phosphorus (t=5.203, P=0.006) levels, but decreased platelet count (t=3.469, P=0.032) and serum sodium (t=9.821, P＜0.000) levels. Multivariate Logistic regression analysis identified independent ICH risk factors: stroke history (OR=1.610, 95% CI:1.021～4.320, P=0.041), elevated mean pre-dialysis SBP within 3 months (OR=2.526, 95% CI:1.470～5.323, P=0.004), hemodialysis (OR=3.190, 95% CI: 1.620～6.270, P=0.007), white matter hyperintensity (OR=3.521,95% CI:1.313～6.482, P=0.030), and cerebral microhemorrhage (OR=2.797,95% CI:1.168～6.701, P=0.011). At 3-month follow-up,  31.0% (13/42) of ICH patients had favorable outcomes (modified Rankin scale, mRS ≤2)；while 69.0% (29/42) had poor outcomes (mRS>2), including 4 deaths (9.5%).   Conclusion  ESRD patients face elevated ICH risk with relatively poor prognosis in this population. 

Key words: End stage renal disease, Cerebral hemorrhage, Risk factors, Prognosis

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