高危小卒中/短暂性脑缺血发作患者血压变异性与早期神经功能恶化的相关性

Blood pressure variability and early neurological deterioration in high-risk patients with acute minor stroke or transient ischemic attack

目的探讨高危小卒中/TIA患者血压变异性(BPV)与早期神经功能恶化(END)的相关性。方法连续前瞻性选择2017年5月至2019年5月期间在扬州大学附属医院神经内科住院治疗的急性高危小卒中/TIA患者。根据住院72 h内美国国立卫生院卒中量表(NIHSS)评分的动态变化,将患者分为END组和非END组。对2组患者各项BPV参数进行分析和比较,主要包括收缩压(SBP)和舒张压(DBP)的平均值(mean)、最大值(max)、极差(max-min)、标准差(SD)、变异系数(CV)。探讨不同BPV参数与高危小卒中/TIA患者早期END的关系。结果共纳入符合入组/排除标准的患者102例,男性58例,女性44例,平均年龄(62.87±12.00岁)。住院72 h内,有27(26.5%)例患者发生END。单因素分析表明,END组患者和非END组患者间年龄、性别、白细胞、C反应蛋白、SBPmax-min、SBPSD、SBPCV、DBPmax-min、DBPSD、DBPCV的差异均具有统计学意义(P均<0.05)。校正单因素分析中P<0.1的变量(包括年龄、性别、白细胞、C反应蛋白),Logistics回归分析表明,血压变异指标中的SBPmax-min[1.026(1.002~1.050)],SBPSD[1.124(1.006~1.256)],SBPCV[1.277(1.068~1.526)],DBPmax-min[1.084(1.021~1.151)],DBPSD[1.560(1.166~2.088)],DBPCV[1.439(1.154~1.793)]是高危小卒中/TIA患者入院72 h内发生END的独立危险因素。结论较高的血压变异性可能会增加高危小卒中/TIA患者END的发生风险。

Objective To analyze the relationship between blood pressure(BP)variability(BPV)and early neurological deterioration(END)in high-risk patients with acute minor stroke or transient ischemic attack.Methods Patients with acute minor stroke or transient ischemic attack were consecutively recruited at the Affiliated Hospital of Yangzhou University between May 2017 and May 2019 and divided into two groups according to the presence of END or not.During the first 72 hours,the parameters of BPV such as BPmax,BPmax-min,BPSD,and BPCV were calculated.Results A total of 102 patients were recruited in this study,of whom 27(26.5%)developed END.Univariate analysis indicated that age,sex,white blood cell count,C reactive protein,and BPV parameters such as SBPmax-min,SBPSD,SBPCV,DBPmax-min,DBPSD,and DBPCV were significantly associated with the development of END(P<0.05).After adjusting the parameters with a P-value<0.1,logistic regression analysis demonstrated that SBPmax-min(1.026[1.002-1.050]),SBPSD(1.124[1.006-1.256]),SBPCV(1.277[1.068-1.526]),DBPmax-min(1.084[1.021-1.151]),DBPSD(1.560[1.166-2.088]),and DBPCV(1.439[1.154-1.793])were all independently associated with the development of END in high-risk patients with acute minor stroke or transient ischemic attack.Conclusion Our study indicated that higher in-hospital BPV may increase the risk of END in highrisk patients with acute minor stroke or transient ischemic attack.