伴高同种半胱氨酸血症的高血压与脑出血患者早期神经功能恶化的相关性

Correlation of hypertension with hyperhomocysteinemia and early neurological deterioration in patients with intracerebral hemorrhage

目的探讨伴高同种半胱氨酸血症(hyperhomocysteinemia,HHcy)的高血压与脑出血患者早期神经功能恶化(early neurological deterioration,END)的关系。方法前瞻性纳入2017年1月至2018年12月期间淮南市第一人民医院神经内科收治的急性脑出血患者。END定义为入院72 h内任意时间美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分增加≥4分或格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分降低≥2分。比较END组与非END组的基线资料,应用多变量logisitic回归分析评估END的独立危险因素。结果共纳入238例急性脑出血患者,其中64例(26.9%)发生END。END组患者伴HHcy的高血压比例、血糖、同种半胱氨酸水平、中性粒细胞计数、出血破入脑室比例、血肿增大比例、基线血肿体积、基线NIHSS评分均显著高于非END组,而基线GCS评分显著低于非END组(P均<0.05)。多变量logistic回归分析显示,校正混杂因素后,基线血肿体积[优势比(odds ratio,OR)1.086,95%可信区间(confidence interval,CI)1.029~1.146;P=0.003]、基线GCS评分(OR 0.420,95%CI 0.245~0.719;P=0.002)及伴HHcy的高血压(OR 2.441,95%CI 1.185~5.029;P=0.016)与END存在显著独立相关性。结论伴HHcy的高血压是脑出血患者发生END的独立预测因素。

Objective To investigate the relationship between hypertension with hyperhomocysteinemia(HHcy)and early neurological deterioration(END)in patients with intracerebral hemorrhage.Methods Patients with acute intracerebral hemorrhage admitted to the Department of Neurology,the First People's Hospital of Huainan from January 2017 to December 2018 were enrolled prospectively.END was defined as the National Institutes of Health Stroke Scale(NIHSS)score increased by≥4 or Glasgow Coma Scale(GCS)score decreased by≥2 at any time within 72 h after onset from baseline.The baseline data of the END and non-END groups were compared,and multivariate logistic regression analysis was use to evaluate the independent risk factors for END.Results A total of 238 patients with acute intracerebral hemorrhage were enrolled,and 64 of them(26.9%)developed END.The baseline hematoma volume,NIHSS score,blood glucose,homocysteine level,neutrophil count,and the proportion of hypertension,hemorrhage into ventricle and hematoma enlargement in the END group were significantly higher than those in the non-END group,while the baseline GCS score was significantly lower than that in the non-END group(all P<0.05).Multivariate logistic regression analysis showed that after adjusting for the confounding factors,the baseline hematoma volume(odds ratio[OR]1.086,95% confidence interval[CI]1.029-1.146;P=0.003),baseline GCS score(OR 0.420,95%CI 0.245-0.719;P=0.002)and hypertension with HHcy(OR 2.441,95%CI 1.185-5.029;P=0.016)had significant independent correlation with END.Conclusion Hypertension with HHcy is an independent predictor of END in patients with intracerebral hemorrhage.