脑梗死急性期24h血压变异与患者早、中期预后的关系研究

Association of 24-hour blood pressure variability with functional outcome on discharge and midterm outcome in patients with acute ischemic stroke

目的探讨脑梗死急性期24h血压变异和卒中早期及中期功能预后的关系。方法采用病例对照的研究方法．连续登记自2013年1月至2015年12月在东莞市人民医院卒中中心住院治疗的急性脑梗死患者，动态监测入院后24h血压并计算血压变异参数，采用改良Rankin（mRS）量表对患者出院时（早期）和6个月后（中期）预后进行评价（mRS评分≤2分为预后良好，mRS评分〉2分为预后不良）。比较不同预后患者临床特征和血压参数，建立二元Logistic回归模型分析血压变异参数与早期、中期不同预后的关系。结果研究共纳入188例患者，早期预后不良67例（35．6％），中期预后不良95例（50．5％）。早期预后不良组患者24h平均收缩压和收缩压变异系数高于预后良好组患者[（149．6±20．0）mmHgvs.（137．6±20．2）mmHg；（13．4±3．8）mmHgvs.（12．1±3．8）mmHgl，差异有统计学意义（P〈0．05）。多因素校正后提示，24h收缩压的均值和标准差增大是早期预后不良的独立预测因子（OR=1．284，95％CI=1．067～1．544，P=0．008；OR=1．098，95％CI=1．016-1．188，P=-0．019）。中期预后不良组患者24h收缩压均值大于预后良好组患者（（146．6±20．6）mmHgvs.（137．1±20．2）mmHgl，差异有统计学意义（P〈0．05），是中期预后不良的独立预测因子（OR=1．198，95％CI=1．005～1．427．P=0．043）。结论24h收缩压变异增大是急性脑梗死早期预后不良的独立危险因素．与脑梗死后中期预后无明显相关。

Objective To elucidate whether 24-hour blood pressure （BP） variability in the acute phase of ischemic stroke is associated with functional outcomes. Methods Case-control study was performed in patients with acute ischemic stroke admitted to our hospital from January 2013 to December 2015. Clinical data and 24-hour continuous BP monitoring data right after admission were recorded, and BP variability profiles were subsequently calculated. Functional outcomes were evaluated with modified Rankin scale （mRS） on discharge and at 6 months after discharge respectively （favorable outcome： mRS scores ≤2; poor outcome： mRS scores〉2）. BP variability profiles were compared with distinctive functional outcomes. Logistic regression models were established to investigate factors contributing to poor outcome on discharge and at 6 months after discharge. Results Of 188 eligible patients, 67 （35.6%） discharged with poor outcome and 95 （50.5%） were reported poor outcome at 6 months follow-up. Patients with poor outcome on discharge had significantly higher 24-hour mean systolic blood pressure （SBP, [149.6±20.0] mmHg vs. [137.6±20.2] mmHg） and SBP standard variation （SBP-SD, [13.4±3.8] mmHg vs. [12.1±3.8] mmHg, P〈0.05）. After adjusting for crude variables, the increase of 24-hour mean SBP and SBP-SD was independently associated with poor outcome on discharge （OR=1.284,95%CI=1.067-1.544, P=0.008; OR=1.098, 95%CI=1.016-1.188, P=-0.019）. Patients with poor outcome at 6 month after discharge had significantly higher 24-hour mean SBP （[146.6±20.6] mmHg vs. [137.1 ± 20.2] mmHg, P〈0.05）. Conclusion Increased 24-hour BP variability after admission is associated with early functional outcome in patients with acute ischemic stroke, but not with midterm outcome.