每日间血压变异性与急性缺血性卒中后转归的相关性

Correlation between day-by-day blood pressure variability and outcome after acute iscbemic stroke

目的探讨急性缺血性卒中后1周内每日间血压变异性与6个月时转归的相关性。方法连续登记2013年1月至2015年12月住院治疗的急性缺血性卒中患者，监测入院后7d内每日清晨血压并计算血压变异性参数。随访6个月，根据改良Rankin量表（modified Rankin Scale，nmS）进行转归评价，转归良好定义为mRS评5〉0～2分。比较转归良好组与转归不良组的临床特征、血压和每日间血压变异性参数。应用多变量logistic回归分析确定每日间血压变异性参数与6个月时转归的相关性。结果共纳入169例患者，其中89例（52．7％）转归不良。转归不良组每日间平均收缩压[（147．1±15．9）mmHg对（139．6±19．0）mmHg；t=2．666，P=0．008；1mmHg=0．133kPa]、收缩压标准差[中位数和四分位数间距：16．5（13．7～19．4）mmHg对13．4（10．7～18．3）mmHg；Z=2．909，P=0．004]和收缩压最大值与最小值之差[47．0（38．0—56．0）mmHg对37．0（29．0～49．0）mmHg；Z=3．634，P〈0．001]均显著高于转归良好组。多变量logistic回归分析显示，每日间收缩压极差值增大是急性缺血性卒中发病后6个月时转归不良的独立危险因素（优势比1．028，95％可信区间1．007～1．050；P=0．008）。结论急性缺血性卒中急性期每日间血压变异性高与转归不良独立相关。

Objective To investigate correlation between the day-by-day blood pressure variability within 1 week and the outcomes at 6 months after acute ischemic stroke. Methods From January 2013 to December 2015, the patients with acute ischemic stroke admitted to hospital were registrated consecutively. Blood pressure was monitored every morning within 7 d after admission and the parameters of blood pressure variability were calculated. They were followed up for 6 months. The outcomes were evaluated according to the modified Rankin scale （mRS）. Good outcome was defined as the mRS score 0 to 2. The clinical characteristics, blood pressure and day-by-day blood pressure variability parameters were compared between the good outcome group and the poor outcome group. Multivariable logistic regression analysis was used to determine the correlation between the day-by-day blood pressure variability and the outcomes at 6 months. Results A total of 169 patients were enrolled in the study, including 89 （52. 7%） with poor outcomes. The day-by-day mean systolic blood pressure （147. 1 ± 15.9 mmHg vs. 139. 6 ± 19. 0 mmHg, t =2. 666, P = 0. 008; 1 mmHg = 0. 133 kPa）, standard deviation of systolic blood pressure （median and interquartile range： 16.5 [13.7-19.4] mmHgvs. 13.4 E10.7-18.3] mmHg;Z=2.909, P=0.004）,andnmdmum- minimum difference of systolic blood pressure （47.0 [38.0-56.0] mmHgvs. 37.0 [29.0-49.0] mmHg; Z= 3. 634, P 〈0. 001） of the poor outcome group were sigaificantly higher than those of the good outcome group. Multivariate logistic regression analysis showed that the daily increased maximum-minimum difference of systolic blood pressure was an independent risk factor for poor outcome at 6 month after onset （odds ratio, 1.028, 95%confidence interval 1.007-1.050; P =0. 008）. Condusions Increased day-by-day blood pressure variability was independently associated with the poor outcome after acute ischemic stroke.