急性缺血性卒中患者血压变异性与认知损害的相关性

Correlation between blood pressure variability and cognitive impairment in patients with acute ischemic stroke

目的探讨血压变异性与急性缺血性卒中患者卒中后认知损害的相关性。方法纳入急性缺血性卒中住院患者，收集人口统计学和临床资料，计算发病7d内血压变异系数，在发病后3个月时采用蒙特利尔认知评估量表评价认知功能。采用多变量logistic回归分析确定发病7d内血压变异系数与发病后3个月认知损害的关系。结果共纳入708例急性缺血性卒中患者。3个月随访时，510例（72．0％）存在认知损害，198例（28．0％）认知功能正常。认知损害组收缩期血压变异系数（8．3±1．2对8．7±1．4；t=-3．299，P=0．001）和舒张期血压变异系数（7．8±1．3对8．0±1．5；t=-2．529，P=0．012）均显著高于认知功能正常组。以第1五分位数组为参照，校正其他混杂因素后，多变量logistic回归分析显示，发病后3个月认知功能损害与7d内收缩压变异系数显著相关，第2～5五分位数的优势比及95％可信区间分别为2．33（1．18～4．60）、2．31（1．15～4．66）、2．70（1．29～5．65）和4．82（1．92～12．1）（P均〈0．05）。结论缺血性卒中急性期收缩压变异性与认知损害相关。

Objective To investigate the correlation between blood pressure variability and cognitive impairment in ischemic stroke. Methods The inpatients with acute ischemic stroke were enrolled. The demographic and clinical data were collected. The coefficient of variation of blood pressure within 7 days after onset was calculated. Montreal Cognitive Assessment was used to evaluate the cognitive function at three month after onset. Multivariate logistic regression analysis was used to identify the relationship between the coefficient of variation of blood pressure within 7 days and the cognitive impairment at 3 months after onset, Results A total of 708 patients with acute ischemic stroke were enrolled in the study. At 3-month follow-up, 510 patients （72.0%） had cognitive impairment and 198 （28.0%） had normal cognitive function. The coefficient of variation for systolic blood pressure （8.3 ± 1. 2 vs. 8.7 ± 1.4; t = -3.299, P =0. 001） and coefficient of variation for diastolic blood pressure （7.8 ± 1.3 vs. 8.0 ± 1.5; t = -2. 529, P =0. 012） in the cognitive impairment group were significantly higher than those in the normal cognitive function group. With the first quintile as a reference, after adjusting other confounding factors, multivariate logistic regression analysis showed that cognitive impairment at 3 months after onset was significantly associated with coefficient of variation for systolic blood pressure. The odds ratios and 95% confidence intervals for the 2-5 quantile groups were 2. 33 （1.18-4. 6）, 2.31 （1.15-4. 66）, 2. 70 （1.29-5.65）, and 4. 82 （1.92- 12. 1）, respectively （all P〈 0.05）. Conclusion Systolic blood pressure variability in the acute phase of ischemic stroke is associated with cognitive impairment.