非心源性缺血性卒中患者急性期短时血压变异性与近期转归的相关性

Correlation between the short-term blood pressure variability and the recent outcome in patients with noncardioembolic ischemic stroke

目的探讨非心源性缺血性卒中患者急性期短时血压变异性与近期转归的相关性。方法连续纳入2013年1月1日至2015年6月31日期间收治的急性期非心源性缺血性卒中患者，收集人口统计学和临床资料，进行24 h动态血压监测并计算各项血压变异性参数。在患者出院时或住院第14天时采用改良Rankin量表（modified Rankin Scale, mRS）评价近期神经功能转归，mRS评分0～2分定义为转归良好，〉2分定义为转归不良。采用多变量logistic回归分析判定血压和短时血压变异指标与近期神经功能转归的相关性。结果总共纳入229例急性期非心源性缺血性卒中患者，40.2%的患者近期功能转归不良。近期功能转归不良组平均收缩压[（147.8±19.6）mmHg对（137.7±19.1）mmHg；t＝3.868，P〈0.001；1 mmHg＝0.133 kPa]和平均收缩压实际变异值（中位数，四分位数间距）[11.7（10.0～14.0）mmHg对10.6（8.2～12.5）mmHg；Z＝3.544，P〈0.001]显著高于功能转归良好组。多变量logistic回归分析显示，校正其他混杂因素后，平均收缩压水平增高（每增高10 mmHg：优势比1.189，95%可信区间1.013～1.369；P＝0.034）和收缩压实际变异增大（每增加1 mmHg：优势比1.182，95%可信区间1.046～1.336；P＝0.008）与近期功能转归不良相关。 结论急性期非心源性缺血性卒中患者短时血压变异增大与近期功能转归不良相关。

ObjectiveTo investigate the correlation between the short-term blood pressure variability and the recent outcome in patients with noncardioembolic ischemic stroke.MethodsThe patients with acute noncardioembolic ischemic stroke admitted to hospital between January 1, 2013 to June31, 2015 were enrolled consecutively. The demographic and clinical data were collected, and 24 h ambulatory blood pressure monitoring was performed and each blood pressure variability parameter was calculated. The modified Rankin scale （mRS） was used to evaluate recent neurological outcome at the time of discharge or the fourteenth day in hospital. The mRS score 0-2 was defined as good outcome, and 〉2 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the correlation between the blood pressure and the short-term blood pressure variability indicators and recent neurological outcome.ResultsA total of 229 patients with acute noncardioembolic ischemic stroke were enrolled, and 40.2% of them had recent poor functional outcome. The mean systolic pressure （147.8±19.6 mmHg vs. 137.7±19.1 mmHg; t=3.868, P〈0.001; 1 mmHg=0.133 kPa） and the actual variation value of the mean systolic pressure （median, interquartile 11.7 [10.0-14.0] mmHg vs. 10.6 [8.2-12.5] mmHg; Z=3.544, P〈0.001） of the recent poor outcome group were significantly higher than those of the good functional outcome group. Multivariate logistic regression analysis showed that after adjusting other confounders, the increased mean systolic pressure （each 10 mmHg increase： odds ratio 1.189, 95% confidence interval 1.013-1.369; P=0.034） and the enlarged actual variation of systolic blood pressure （each 1 mmHg increase： odds ratio 1.182, 95% confidence interval 1.046-1.336; P=0.008） were associated with the recent poor functional outcome.ConclusionsThe increased short-term blood pressure variability was associated with the recent poor functional outcome in patients with acute noncardioembolic ischemic stroke.