血压变异性与缺血性卒中静脉溶栓后发生症状性颅内出血的相关性研究

Correlation between blood pressure variability and symptomatic intracerebral hemorrhage of ischemic stroke after intravenous thrombolysis

目的探讨早期血压变异性(BPV)预测急性缺血性卒中(AIS)静脉溶栓(IVT)后发生症状性颅内出血(s ICH)风险的价值。方法纳入2012至2016年的发病4.5 h内行重组组织型纤溶酶原激活剂IVT且临床资料完整的AIS患者。依据溶栓治疗后48 h内头颅CT或MRI结果及NIHSS评分变化分为s ICH组(22例)和非s ICH组(157例)。采用单因素t、χ2检验和多因素Logistic回归分析2组s ICH危险因素的差异性。进一步分别将24 h收缩压标准差(24hSBPsd)和24h舒张压标准差(24hDBPsd)以四分位数分为4组,以最低四分位组为参照组,其余组分别与参照组比较。结果单因素分析表明,s ICH组年龄、纤维蛋白原(FIB)、吸烟史、24hSBPsd、24hDBPsd均高于非s ICH组(均P<0.05)。多因素Logistic回归分析表明,s ICH组年龄(OR 3.117,95%CI 1.089～8.920)、吸烟史(OR 2.933,95%CI 1.042～8.257)及24hSBPsd(OR 4.135,95%CI 1.397～12.237)均仍高于非s ICH组(均P<0.05),而2组之间FIB、24hDBPsd比较,差异无统计学意义(P>0.05)。校正年龄、吸烟史危险因素后,最高四分组24hSBPsd、24hDBPsd发生s ICH风险分别是最低四分位组的10. 882倍(95%CI 2. 088～56. 717)、6. 025倍(95%CI 1. 550～23.417),差异均有统计学意义(P<0.05)。结论早期BPV越大,发生IVT后s ICH风险越高,以收缩压变异性的影响更明显。

Aim To explore the value of early blood pressure variability( BPV) in predicting the risk of symptomatic intracerebral hemorrhage( s ICH) after intravenous thrombolysis( IVT) in acute ischemic stroke( AIS). Methods AIS patients were collected who received recombinant tissue plasminogen activator IVT within 4.5 hours of onset from2012 to 2016 with complete clinical data. According to skull CT or MRI findings and NIHSS scores within 48 hours after IVT therapy,the patients were divided into s ICH group( 22 cases) and non-sICH group( 157 cases). The differences of s ICH risk factors between the two groups were analyzed by single factor t test,χ^2test and multivariate Logistic regression analysis. The 24-hour systolic blood pressure standard deviation( 24hSBPsd) and 24-hour diastolic blood pressure standard deviation( 24hDBPsd) were further divided into four groups in quartiles,with the lowest quartile group as the reference group,and the rest groups were compared with the reference group,respectively. Results Univariate analysis showed that age,fibrinogen( FIB),smoking history,24 hSBPsd and 24 hDBPsd in s ICH group were higher than those in non-sICH group( all P<0.05). Multivariate Logistic regression analysis showed that age( OR 3.117,95% CI 1.089-8.920),smoking history( OR 2.933,95% CI 1.042-8.257) and 24hSBPsd( OR 4.135,95% CI 1.397-12.237) in s ICH group were still higher than those in non-sICH group( all P<0.05);There was no significant difference in FIB and 24 hDBPsd between the two groups( P>0.05). After adjusting for risk factors of age and smoking history,the risks of s ICH in 24 hSBPsd and24hDBPsd of the highest quartile group were 10. 882 times( 95% CI 2. 088-56. 717) and 6. 025 times( 95% CI 1. 550-23.417) higher than those of the lowest quartile group,respectively,and the differences were statistically sigificant( P <0.05). Conclusion The higher the early BPV,the higher the risk of s ICH after IVT,and the more obvious the influence of systolic blood pressure variability.