缺血性卒中急性期血压水平与卒中后认知障碍的关系

Association between blood pressure in acute phase of ischemic stroke and post-stroke cognitive impairment

目的探讨缺血性卒中急性期血压水平与卒中后认知障碍的关系。方法选取发病24 h内住院的首发急性缺血性脑卒中患者796例,急性期收缩压或舒张压定义为卒中发病7 d内的平均收缩压或平均舒张压,Mo CA分值〈26分判定为认知障碍。对比分析患者入院时、发病14 d、发病3个月、发病6个月、12个月的Mo CA分值和认知障碍患病率,并将急性期血压值按五等分分组（Q1-Q5）,采用多参数对数回归分析急性期血压水平与卒中发病3个月认知障碍的关系。结果卒中发病3个月后认知障碍（post-stroke cognitive impairment,PSCI）患病率最高（71.89%）,以后各时相点逐渐下降。以Q3为参照,经多参数调整后,血压过低（Q1-SBP 102-127 mm Hg）或过高（Q5-SBP〉170-215 mm Hg）,PSCI发病风险均高（Q1-SBP的OR=1.83,95%CI=1.64-2.28,P=0.007;Q5-SBP的OR=2.32,95%CI=1.74-2.90,P〈0.01）。DBP和MBP与SBP具有类似特征。结论缺血性卒中急性期血压过高或过低均是PSCI发病的风险因素,将血压维持在某一＂适当水平＂可能有助于降低PSCI的发病风险。

Objective To investigate the relationship between blood pressure in acute phase of ischemic stroke and post-stroke cognitive impairment（ PSCI）. Methods Seven hundreds and ninety six patients with first onset of acute ischemic stroke hospitalized within 24 h were recruited in this study. The average systolic blood pressure（ SBP） or diastolic blood pressure（ DBP） within 7 d of onset was defined as SBP or DBP at acute phase. The patients with cognitive impairment were judged as Montreal cognitive assessment（ Mo CA） 26 points. The Mo CA scores and the prevalence of cognitive impairment at admission,14 d,and 3,6,and 12 months were dynamically analyzed,and the blood pressure value at acute phase was quintile（ Q1 - Q5）. A multiple parameter logistic regression analysis was conducted to determine the relationship between blood pressure levels at acute phase and the Mo CA scores measured at 3 months after onset. Results The prevalence of PSCI was highest（ 78. 91%） at 3 months after stroke,and gradually decreased after each time point. Taking Q3 group as a reference,the risk of PSCI was the highest（ OR =1. 83,95% CI： 1. 64 - 2. 28,P = 0. 007） in Q1-SBP（ 102 - 127 mm Hg） and was also the highest（ OR =2. 32,95% CI： 1. 74 - 2. 90,P〈0. 001） in Q5-SBP（ 〉170 - 215 mm Hg）. Mean blood pressure,DBP and SBP had similar characteristics. Conclusion Too high or too low blood pressure level at acute phase of ischemic stroke is the predictor of PSCI,and remaining the blood pressure at rational level may help to reduce the risk of PSCI.