原发性高血压患者缺血性小卒中后自主神经功能紊乱的危险因素

Clinical Characteristics of Autonomic Dysfunction in Hypertensive Patients with Minor Ischemic Stroke

目的研究高血压性缺血性小卒中患者自主神经功能紊乱的临床特征及其危险因素。方法收集高血压性缺血性小卒中患者60例(观察组)及与之年龄、性别匹配的高血压患者60例(对照组)的临床资料。用自主神经症状量表(SCOPA-AUT)评价自主神经功能,汉密尔顿抑郁量表(HAM-D)进行抑郁评分。比较两组年龄、心率、合并症、SCOPA-AUT及HAM-D等方面的差异。结果与对照组比较,观察组直立性低血压发生率、抑郁症发生率、SCOPA-AUT、及HAM-D明显增高,差异有统计学意义(P<0.05)。Logistic回归分析显示,HAM-D>8〔标准偏回归系数(β)=0.142,比值比(OR)=3.251,P=0.009〕和年龄>60岁(β=0.180,OR=1.972,P=0.003),是观察组SCOPA-AUT增高的独立危险因素。结论高血压性缺血性小卒中后容易出现自主神经功能紊乱,其发生与卒中后抑郁症和高龄有关。

Objective To investigate clinical characteristics of autonomic dysfunction （AD） in hypertensive patients with minor ischemic stroke （MIS）. Methods Sixty hypertensive patients with MIS （observation group） and 60 age-matched hypertensive patients （control group） were recruited in our study. The clinical data of the patients were collected. Autonomic symptoms were accessed using the Scale for Outcomes in Parkinson disease- Autonomic （SCOPA-AUT）. Depression was evaluated with Hamilton Depression Scale （HAM-D） . Age, heart beat rate, concomitant diseases, SCOPA-AUT, and HAM-D were analyzed between the two groups. Results Compared with the control group, the observation group showed an increased incidence of orthostatic hypotension, depression, SCOPA-AUT and HAM-D score. Logistic regression showed HAM-D score〉 8 [standard partial regression coefficent （β）=0. 142, odds ratio （OR）=3. 251, P=0. 0093 and age〉60 yr. （β=0. 180, OR=1. 972, P= 0. 003） were independent risk factors for AD. Conclusion AD is common in hypertensive patients with MIS and depression is probably the potential etiology.