H型高血压增加脑梗死的复发风险

Correlation of H-hypertension and recurrent cerebral infarction

目的探讨H型高血压与脑梗死复发风险的相关性。方法前瞻性观察2004年1月至2008年1月于北京朝阳医院神经内科住院的急性脑梗死患者656例,随访1年记录卒中复发情况并分为复发组和非复发组。同时于急性发病3d内采用高效液相色谱法测定血清同型半胱氨酸(Hcy)水平,以Hcy≥10μmol/L作为高同型半胱氨酸血症(HHcy)的标准。高血压伴HHcy者为H型高血压组,单纯高血压或单纯HHcy为非H型高血压组。结果 (1)656例急性脑梗死患者中111例复发,1年复发率为16.9%。(2)复发组患者83.8%具有高血压病史,明显高于非复发组的70.6%;血清同型半胱氨酸水平[(22.39±9.45)μmol/L]亦明显高于非复发组[(16.94±9.85)μmol/L],两组比较均具有统计学差异(P<0.01);复发组H型高血压的比例为78.2%,明显高于非复发组的65.1%(P<0.01)。(3)多因素Logistic回归分析结果显示影响脑梗死复发的独立危险因素有H型高血压、高龄、高血压、HHcy和低高密度脂蛋白。结论 H型高血压是脑梗死复发的独立危险因素,应综合防治卒中复发。

Objective To investigate the correlation of H-hypertension and recurrent cerebral infarction.Methods Prospective study was performed from January 2004 to January 2008 at the Beijing Chaoyang Hospital,Department of Neurology,656 cases of acute cerebral infarction patients were followed up for 1-year to record stroke recurrence.All patients were divided into recurrent and non-recurrent group according to their clinical evidence and cranial CT or MRI.Serum homocysteine（Hcy） was examined within 3 days of stroke onset by using high performance liquid chromatography.Hcy level≥10 μmol/L as high homocysteine（HHcy） standard,high blood pressure associated with HHcy were classified as the H-hypertension.Results（1）In 656 cases of acute cerebral infarction,111 cases were of recurrence,1 year recurrence rate was 16.9%.（2）83.8% of patients in the recurrent group showed a history of hypertension,significantly higher than 70.6% in the non-recurrence group;plasma Hcy levels[（22.39±9.45）μmol/L]in the recurrent group was significantly higher than that in the non-recurrent group[（16.94±9.85）μmol/L],the two groups were statistically different（P0.01）.The proportion of H-hypertension in recurrent group were 78.2%,significantly higher than 65.1% in the non-recurrence group（P0.01）.（3）Logistic regression analysis showed that age,hypertension,high Hcy,low high-density lipoprotein and H-hypertension were the independent risk factors for stroke recurrence.Conclusions H-hypertension is an independent risk factor for stroke recurrence,relapse prevention of stroke should be integrated,especially for hypertension and HHcy.