血压晨峰与进展性缺血性卒中的相关性研究

Correlation between Morning Blood Pressure Surge and Progressive Ischemic Stroke

目的探讨血压晨峰与进展性缺血性卒中(PIS)的相关性。方法选取2012年10月—2013年10月本院神经内科收治的急性缺血性卒中患者240例,根据欧洲进展性卒中研究组对进展性卒中的诊断标准,将患者分为进展性卒中组及非进展性卒中组。对患者导致PIS的相关危险因素进行单因素及多因素分析,并比较血压晨峰升高患者与非血压晨峰升高患者中PIS发生率。结果 240例急性缺血性卒中患者中,进展性卒中组72例(30.0%),非进展性卒中组168例(70.0%)。进展性卒中组患者血压晨峰值、平均动脉压、血浆纤维蛋白原水平及高脂血症、发病1周内感染、颅内动脉狭窄、颈内动脉狭窄、心房纤颤发生率均高于非进展性卒中组(P<0.05)。血压晨峰升高患者PIS的发生率高于非血压晨峰升高患者〔55.0%(44/80)与17.5%(28/160),χ2=8.929,P=0.003〕。进一步以是否发生PIS为因变量,经二元逐步Logistic回归分析,发现血压晨峰升高、血浆纤维蛋白原水平升高、颅内动脉狭窄及心房纤颤是PIS的独立危险因素(P<0.05)。结论血压晨峰升高的缺血性卒中患者PIS发生率升高,而且血压晨峰升高是导致PIS的独立危险因素。

Objective To discuss the correlation between morning blood pressure surge and progressive ischemic stroke. Methods 240 patients with acute cerebral infarction admitted to the neurology department from October 2012 to October 2013 were divided into progressive ischemic stroke group and non -progressive ischemic stroke group according to the diagnosis criteria of progressive stroke enacted by European Progressing Stroke Study Group .Single and multiple factors analysis on risk fac-tors of progressive ischemic stroke between the two groups were made and the incidence of progressive ischemic stroke was com -pared between higher and normal morning blood pressure surge .Results Among the 240 patients of acute ischemic stroke , 72 （30.0%） were in progressive ischemic stroke group and 168 （70.0%） were in non-progressive ischemic stroke.The value of morning blood pressure surge , mean arterial pressure , plasma fibrinogen and the incidences of hyperlipidaemia , infections within one week, intracranial arterial stenosis , internal carotid artery stenosis and atrial fibrillation in progressive ischemic stroke group were all higher than the non -progressive ischemic stroke group （P〈0.05） .The incidence of progressive ischemic stroke in pa-tients with higher morning blood pressure surge was higher than patients with normal morning blood pressure surge 〔55.0% （44/80） vs.17.5% （28/160）, χ2 =8.929, P=0.003〕 .Binary multivariable Logistic regression analysis with progressive ische-mic stroke as dependent variable showed that the value of morning blood pressure surge , plasma fibrinogen and the incidence of intracranial arterial stenosis, artrial fibrillation were independent risk factors of progressive ischemic stroke （P〈0.05）.Con-clusion The incidence of progressive ischemic stroke is higher in patients with ischemic stroke who have elevated morning blood pressure surge , and the elevated morning blood pressure surge was independent risk factor for progressive ischemic stroke .