高收缩压轨迹是脑出血的危险因素

High systolic blood pressure trajectory was a risk factor for cerebral hemorrhage

目的探讨不同的收缩压轨迹对脑出血的影响。方法以参加2006-2007、2008-2009和2010-2011年3次健康体检的开滦研究人群作为研究队列,其中符合入选标准的研究对象共55 194人。收缩压轨迹通过SAS Proc Traj程序确定;采用寿命表法计算不同收缩压轨迹组脑出血的累积发生率,并用Log-rank检验比较不同收缩压轨迹组脑出血累积发生率的差异;采用Cox比例风险模型分析不同收缩压轨迹组对脑出血的影响。结果纳入统计分析的研究对象55 194人通过SAS Proc Traj程序确定了5组不同的收缩压轨迹:低-稳定组、正常-稳定组、中-高组、高-中组和高-稳定组。平均随访(4.99±0.39)年,共发生脑出血164例。低-稳定组、正常-稳定组、中-高组、高-中组和高-稳定组脑出血的累积发生率分别为0.05%、0.20%、0.80%、0.60%和0.80%(P<0.01)。多因素Cox回归分析显示,在校正多种混杂因素后,与低-稳定组相比,正常-稳定组、中-高组、高-中组和高-稳定组脑出血的发生风险均增加,其HR(95%CI)分别为3.48(1.41~8.56)、15.01(5.67~39.71)、11.47(3.70~35.61)和18.40(5.28~64.14)。结论高收缩压轨迹是发生脑出血的独立危险因素。

Objective To explore the effect of various systolic blood pressure trajectories on cerebral hemorrhage. Methods A total of 55 194 participants who underwent the 2006--2007, 2008--2009 and 2010--2011 physical examinations and met the inclusion criteria were enrolled in the study. Proc Traj of SAS software was used to identify systolic blood pressure trajectories. The life table method was used to calculate the cumulative incidence rate of cerebral hemorrhage in different systolic blood pressure trajectory groups, and Log-Rank test was employed to compare the differences in the cumulative incidence rate of cerebral hemorrhage among the groups. Cox proportional hazards models were used to analyze the effect of systolic blood pressure trajectory on cerebral hemorrhage. Results According to systolic blood pressure trajectory identified by Proc Traj of SAS software, 55 194 participants were classified into five groups： low-stable group （the blood pressure was stable in the low level）, normabstable group （the blood pressure was stabe in the normal）, moderate-high group （ blood pressure increased from moderate levels to high levels）, high-moderate group （blood pressure decreased from high levels to moderate levels） and high-stable group （blood pressure was stable in the high level）. The participants were followed up for an average of （4.99 ± 0.39） years, and there were 164 eases of cerebral hemorrhage. The cumulative incidence rate of cerebral hemorrhage was 0.05%, 0.20%, 0. 80%, 0.60% and 0. 80% in the low-stable group, normal-stable group, moderate-high group, high-moderate group and high-stable group, respectively （P〈0. 001）. Cox proportional hazards models showed that after adjusting for confounding factors, compared with the low-stable group, the risk of cerebral hemorrhage in the normal-stable group, moderate-high group, high-moderate group and high-stable group were all increased, and the hazard ratios （95% CI） were 3.48（1.41-8.56） , 15.01（5.67-39.71） , 11.47（3.70-35.61） and 18.40（5.28-64.14）, respectively. Conclusion High systolic blood pressure trajectory was an independent risk factor for cerebral hemorrhage.