Association Of Glomeruar Filtration Rate With Lacunar Infarcts And White Matter Hyperintensity In Elderly Patients

Objective1. To investigate the association of lacunar infarction(LI) with glomeruar filtrationrate(GFR) independent of ambulatory blood pressure (BP) in elderly patients.2. To investigate the association of white-matter hyperintensity (WMH) with GFR inelderly LI patients.MethodsA total of130cases of male LI patients were selected. The average age of80to96years (86.1±4.2years). LI and WMH were detected on MRI. All the patientsaccording to number of lesions divided into less (35cases) and multiple (95cases)groups and according to Fazekas scale (0~6score) for WMH severity assessment,patients were divided into low score group (0~3score,55cases) and high scoregroups(4~6score,75cases). GFR was estimated using the Cockcroft-Gault equation.In continuous and categorical analyses, the association between GFR and theprevalence of LI and WMH was investigated. Multiple logistic regression analysisadjusted for24-hour ambulatory BP, age, body mass index, smoking and drinking status, SCr, antihypertensive medication, blood fat and histories of diabetes mellitusand heart disease was performed.Results1. Compared with less groups, the multiple groups SCr（P=0.008） and GFR <60ml/(min1.73m2)（P=0.001）was significantly higher, GFR was significantlylower（P=0.030）. Logistic regression analysis showed that, decreased GFR(continuous variable) was significantly associated with lacunar infarction afteradjustment for various risk factors, including24-hour ambulatory BP. Decrease inGFR（OR=2.62；95%CI=1.38~4.99；P<0.05）was significantly associated witha high prevalence of lacunar infarction.2. The high score groups in patient ag（eP=0.001）, SC（rP=0.001）and GFR <60ml/(min1.73m2)（P=0.002）compared low score groups was significantlyincreased, drinking history（P=0.026） and GFR（P=0.001）was significantlylower, the difference was statistically significant. Logistic regression analysisshowed that, WMH risk factors were GFR（OR=2.34；95%CI=1.26~4.49；P<0.05）, age（OR=1.23；95%CI=1.07~1.43；P<0.05） and diabetes（OR=4.31；95%CI=1.56~11.91；P<0.05）. In elderly LI patients，decreased GFR wassignificantly associated with WMH after adjustment for various risk factors.Conclusions1. GFR is closely associated with LI, suggesting that decreased GFR in the elderly isan important risk factor or predictor for LI.2. Decreased GFR in the elderly with LI is an important risk factor for WMH.