血压变异性与急性前循环大动脉粥样硬化性卒中患者早期神经功能恶化的相关性

Correlation between blood pressure variability and early neurological deterioration in patients with acute anterior circulation large artery atherosclerotic stroke

目的 探讨血压变异性（blood pressure variability,BPV）与急性前循环大动脉粥样硬化性卒中（large artery atherosclerotic stroke,LAA）患者早期神经功能恶化（early neurological deterioration,END）的相关性.方法 前瞻性纳入2015年1月至2018年6月期间连续收住扬州大学附属医院神经内科的前循环急性缺血性卒中患者,根据病因学分型分为LAA组和非LAA组.通过监测住院72 h内血压,计算收缩压（systolic blood pressure,SBP）和舒张压（diastolic blood pressure,DBP）的平均值（mean）、最大值（maximum,max）、最小值（minimum,min）、极差（difference between maximum and minimum,max-min）、标准差（standard deviation,SD）和变异系数（coefficient of variation,CV;CV=SD×100/mean）.END定义为入院72 h内复评美国国立卫生研究院卒中量表最高分较基线时增加≥2分.采用多变量logistic回归分析确定BPV参数与END的相关性.结果 共纳入271例前循环急性缺血性卒中患者,其中男性170例（62.7％）,女性101例（37.3％）,年龄（64.99±11.51）岁.LAA患者95例（35.1％）,非LAA患者176例（64.9％）.LAA组和非LAA分别有36例（37.9％）和50例（28.4％）发生END.对LAA患者组END患者与非END患者进行的比较显示,年龄、性别、糖尿病、基线美国国立卫生研究院卒中量表评分和C反应蛋白以及BPV参数中SBPmax、SBPmax-min、SBPSD、SBPCV、DBPmax、DBPmax-min、DBPSD和DBPCV的差异具有统计学意义（P均〈0.05）.多变量logistics回归分析显示,多个BPV参数为END的独立危险因素,包括SBPmax[优势比（odds ratio,OR）1.027,95％ 可信区间（confidence interval,CI）1.003～1.052;P=0.027]、SBPmax-min（OR 1.041,95％CI 1.015～1.068;P=0.002）、SBPSD（OR 1.177,95％CI 1.048～1.322;P=0.006）、SBPCV（OR 1.226,95％CI 1.036～1.451;P=0.018）、DBPmax（OR 1.073,95％CI 1.017～1.133;P=0.010）、DBPmax-min（OR 1.107,95％CI 1.044～1.174;P=0.001）、DBPSD（OR 1.693,95％CI 1.268～2.260;P〈0.001）和DBPCV（OR 1.726,95％CI 1.311～2.271;P〈0.001）.而在非LAA患者组,所有BPV参数均与END的发生无显著相关性.结论 BPV与前循环LAA患者END显著相关.

Objective To investigate the correlation between blood pressure variability （BPV） and early neurological deterioration （END） in patients with acute anterior circulation large artery atherosclerotic （LAA）stroke. Methods From January 2015 to June 2018, consecutive patients with anterior circulation acute ischemic stroke admitted to the Department of Neurology, the Affiliated Hospital of Yangzhou University were enrolled prospectively. According to the etiological classification, they were divided into LAA group and non-LAA group. By monitoring the blood pressure within 72 h of hospitalization, the mean, maximum （max）and minimum （min） values, and the difference between max and min （max-min）, standard deviation （SD）,and coefficient of variation （CV; CV = SD × 100/mean） were calculated. END was defined as the highest score of the National Institutes of Health Stroke Scale （NIHSS） within 72 h of admission increased by ≥2than the baseline. Multivariate logistic regression analysis was used to determine the correlation between BPV parameters and END. Results A total of 271 patients with anterior circulation acute ischemic stroke were enrolled, including 101 females （37. 3％） and 170 males （62. 7％）, with an average age of 64. 99 ± 11. 51 years. There were 95 patients （35. 1％） with LAA and 176 （64. 9％） with non-LAA. In the LAA group and non-LAA group, 36 patients （37.9％） and 50 patients （28.4％） developed END respectively. The comparison between END patients and non-END patients in the LAA group showed that there were significant differences in age, sex, diabetes mellitus, baseline NIHSS score and C-reactive protein, as well as SBPmax , SBPmax-min , SBPSD , SBPCV, DBPmax , DBPmax-min , DBPSD , and DBPCV in BPV indices （all P 〈 0. 05）.Multivariate logistic regression analysis showed that many BPV indices were the independent risk factors for END, including SBPmax （odds ratio [OR] 1. 027, 95％ confidence interval [CI] 1. 003-1. 052; P = 0. 027）,SBPmax-min （OR 1. 041, 95％CI 1. 015-1. 068; P = 0. 002）, SBPSD （OR 1. 177, 95％ CI 1. 048-1. 322; P =0. 006）, SBPCV （OR 1. 226, 95％ CI 1. 036-1.451; P = 0. 018）, DBPmax （OR 1. 073, 95％ CI 1. 017-1. 133;P = 0. 010）, DBPmax-min （OR 1. 107, 95％CI 1. 044-1. 174; P = 0. 001）, DBPSD （OR 1. 693, 95％CI 1. 268- 2. 260; P 〈 0. 001）, and DBPCV（OR 1. 726, 95％CI 1. 311-2. 271; P 〈 0. 001）. In the non-LAA group, there were no significant association between all BPV parameters and the occurrence of END. Conclusion BPV was significantly correlated with END in patients with anterior circulation LAA.