【摘要】 目的 探讨原发性膜性肾病(PMN)并发急性脑梗死(ACI)的危险因素。方法 选择2018年7月至2021年5月新乡医学院第一附属医院收治的经临床和肾穿刺病理活检诊断为PMN的93例患者为研究对象，根据是否并发ACI分为PMN并发ACI组(n=30)和PMN未并发ACI组(n=63)。通过查阅病历资料收集患者的临床资料，包括年龄、性别、吸烟史、高血压病史、糖尿病史、既往应用抗凝药物史、病理分期、24 h尿蛋白定量、抗磷脂酶A2受体(PLA2R)抗体滴度、血尿酸(UA)、血清白蛋白(Alb)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、D-二聚体、血小板、总胆固醇(TC);采用单因素分析及多因素logistic回归分析PMN并发ACI的相关危险因素。结果 年龄、性别、吸烟史、高血压病史、糖尿病史、既往应用抗凝药物史、病理分期、24 h尿蛋白定量、抗PLA2R抗体滴度、UA、Alb、TC与PMN并发ACI无关(P>0.05),LDL-C、D-二聚体、血小板、TG水平与PMN并发ACI相关(P<0.05)。多因素logistic回归分析校正年龄、高血压混杂因素后，高水平血小板、LDL-C和D-二聚体是PMN并发ACI的危险因素(比值比=1.008、1.208、1.290,P<0.05)。结论 高水平血小板、D-二聚体和LDL-C是PMN合并ACI的相关危险因素，应早期对这些危险因素进行干预，以预防ACI的发生。更多还原

【Abstract】 Objective To investigate the risk factors of acute cerebral infarction(ACI) in patients with primary membranous nephropathy(PMN).Methods A total of 93 patients with PMN diagnosed by clinical and renal biopsy in the First Affiliated Hospital of Xinxiang Medical University from July 2018 to May 2021 were selected as the research subjects, and they were divided into the PMN complicated with ACI group(n=30) and the PMN without ACI group(n=63) according whether they had ACI.The clinical data was collected by referring to the medical records, including the age, gender, smoking history, hypertension history, diabetes history, anticoagulation medication history, pathological stage, 24 h-urine protein quantitation, anti-phospholipase A2 receptor(PLA2 R) antibody titer, uric acid(UA),serum albumin(Alb) and total cholesterol(TC),low density lipoprotein cholestero(LDL-C),D-dimer, platelet and triglycerides(TG);and the relevant risk factors for PMN complicated with ACI were analyzed by single factor analysis and multi-factor logistic regression.Results The age, gender, smoking history, hypertension history, diabetes history, anticoagulation medication history, pathological stage, 24 h-urine protein quantitation, anti-PLA2 R antibody titer, UA, ALB and TC were not related to PMN complicated with ACI(P>0.05).The LDL-C,D-dimer, platelet and TG levels were correlated with PMN complicated with ACI(P<0.05).After adjusting for age and hypertensive confounders by multivariate logistic regression analysis, high levels of platelets, LDL-C and D-dimer were the risk factors for PMN complicated with ACI(odds ratio=1.008,1.208,1.290;P<0.05).Conclusion High levels of platelet, D-dimer and LDL-C are the related risk factors of ACI in patients with PMN.Early intervention should be made for these risk factors to prevent the occurrence of ACI.更多还原