糖尿病与高血压交互作用对缺血性卒中严重程度的影响

Interaction between diabetes and hypertension on ischemic stroke severity

目的糖尿病和高血压都是卒中的强预测因子,然而两者对卒中严重程度是否存在交互作用仍不明确.文中通过流行病学交互作用的研究方法,探讨糖尿病、高血压及其交互作用对卒中严重程度的影响.方法回顾性分析南京卒中注册系统2 0 1 3年1 月至2 0 1 5年6 月期间于南京军区南京总医院神经内科住院的缺血性卒中患者8 8 6例.卒中严重程度评价采用国立卫生院神经功能评分（ National Institute of Health Stroke Scale, NIHSS） ,NIHSS 〈 1 0分为轻/ 中型卒中,而NIHSS≥1 0 为重型卒中.采用logistic回归分析影响卒中严重程度的因素,糖尿病和高血压交互作用分析采用相加尺度和相乘尺度.最后按患者年龄、性别分层分析糖尿病、高血压的交互作用.结果重型卒中患者2 6 0例,占29.3%.多变量logistic回归调整年龄、性别后,糖尿病（OR = 1.707,9 5 % CI 1.267-2.300）、高血压（0 R = 1.603,9 5 % CI： 1.111 -2.312）增加了重型卒中的危险性.糖尿病、高血压之间存在协同的相加交互作用[相对超危险度比（ the relative excess risk due to interaction, RERI）= 1.001,9 5 % CI：0.099- 1.903],但不存在相乘交互作用（X^2 = 1 . 7 0 0 , = 0.192）.在男性患者中,糖尿病、高血压相乘交互作用（ Pmultiplicative = 0.015）和相加交互作用（R ERI=1.82,95%C I：0.72-2.92）均有统计学意义.结论糖尿病、高血压可能存在交互作用使重型卒中风险显著增加.改善血糖、血压的控制可能会协同参与阻止卒中的发展.

Objective Although both diabetes and hypertension are strong predictors of stroke,the effect of their interaction on stroke severity remains largely unknown. The study investigated the effects of diabetes,hypertension,and their interaction on stroke severity by epidemiological interaction analysis. Methods Retrospective analysis was made on 886 ischemic stroke patients of Nanjing Stroke Registry Program( NSRP) who hospitalized in our department from January 2013 to June 2015 within 48 hours after stroke onset. Stroke severity was assessed by the National Institute of Health stroke scale( NIHSS). Mild/moderate stroke was defined as NIHSS < 10,while severe stroke were those with NIHSS ≥ 10. Logistic regression analysis was used to analyze the factors related to stroke severity. Interaction was observed between diabetes and hypertension on additive scale and multiplicative scale. Additionally,we conducted stratification analyses according to age and sex. Results Severe stroke occurred in 260 patients( 29.3%). When adjusting age and sexby multivariate logistic regression,diabetes( OR = 1. 707,95% CI: 1.267- 2. 300) and hypertension( OR = 1. 603,95% CI: 1. 111-2.312) were associated with severe stroke. Interaction was observed between diabetes and hypertension on the additive scale for stroke severity [the relative excess risk due to interaction( RERI) = 1.00,95%CI: 0.10-1.90]. No significant interaction was detected on the multiplicative scale( χ~2= 1.700,P_(multiplicative)= 0.192). In male patients,the interaction effect showed statistical significance both on multiplicative scale( P_(multiplicative)= 0.015) and additive scale( RERI = 1.82,95%CI: 0.72-2.92). Conclusion There might be an interaction between diabetes and hypertension and their combination may increase the risk of severe stroke drastically. The improvement of blood glucose and blood pressure may be able to prevent the development of stroke synergistically.