老年高血压合并脑梗死后遗症患者血压昼夜节律变化及其预后影响因素分析

Analysis of circadian rhythm of blood pressure and its prognostic factors in elderly hypertensive patients with sequelae of cerebral infarction

目的分析老年高血压合并脑梗死后遗症患者血压昼夜节律变化及其预后影响因素。方法回顾性分析2018年1月-2021年1月川北医学院附属医院收治的152例老年高血压合并脑梗死患者的临床资料,根据有无合并后遗症分为2组:高血压合并脑梗死组(n=92)和高血压合并脑梗死后遗症组(n=60),并对2组患者的24 h、日间和夜间血压平均值和血压昼夜节律性进行统计分析。于发病3个月后,统计不良事件发生率(并发症、脑梗复发及病死),根据有无不良事件发生分为预后不良组(n=55)和预后良好组(n=97),比较2组临床资料,分析影响老年高血压合并脑梗死后遗症患者预后的危险因素。结果高血压合并脑梗死后遗症组的24 h、日间、夜间收缩压和舒张压水平均明显高于高血压合并脑梗死组(P<0.05);高血压合并脑梗死后遗症组的非杓型率明显高于高血压合并脑梗死组(P<0.05),而其杓型率显著低于高血压合并脑梗死组(P<0.05)。高血压合并脑梗死后遗症组的心血管并发症发生率明显高于高血压合并脑梗死组(P<0.005)。Logistic多因素回归分析显示,饮酒史、吸烟史、梗死体积、NIHSS评分、WBC、GLU、UA、CRP、IL-6、LDL-C、收缩压、舒张压及FIB是影响高血压合并脑梗死后遗症患者预后的独立危险因素(P<0.05)。结论老年高血压合并脑梗死后遗症患者血压过高和昼夜节律异常,且合并饮酒史、吸烟史及梗死体积较大和NIHSS评分、WBC、GLU、UA、CRP、IL-6、LDL-C、收缩压、舒张压及FIB高表达的高血压合并脑梗死后遗症患者预后较差,临床应对其进行及时针对性干预,以减少不良预后。

Objective To analyze the changes of circadian rhythm of blood pressure and its prognostic factors in elderly hypertensive patients with sequelae of cerebral infarction.Methods The clinical data of 152 elderly patients with hypertension complicated with cerebral infarction treated in the Affiliated Hospital of North Sichuan Medical College from January 2018 to January 2021 were analyzed retrospectively.According to the presence or absence of sequelae,they were divided into two groups:hypertension with cerebral infarction group(n=92)and hypertension with cerebral infarction sequelae group(n=60).The 24-hour,daytime and nighttime mean blood pressure and circadian rhythm of blood pressure of the two groups were statistically analyzed.The incidence of adverse events(complications,cerebral infarction recurrence and death)was calculated 3 months after the onset of the disease.According to whether adverse events occurred,they were divided into poor prognosis group(n=55)and good prognosis group(n=97).The clinical data of the two groups were compared and the risk factors affecting the prognosis of elderly patients with hypertension complicated with sequelae of cerebral infarction were analyzed.Results The 24-hour,daytime and nighttime systolic blood pressure and diastolic blood pressure of the hypertension combined with cerebral infarction sequelae group were significantly higher than those of the hypertension combined with cerebral infarction group(P<0.05).The rate of non-dipper type in the hypertension with cerebral infarction sequelae group was significantly higher than that in hypertension with cerebral infarction group(P<0.05),and the rate of dipper type was significantly lower than that in hypertension with cerebral infarction group(P<0.05).The incidence of cardiovascular complications in the hypertension with cerebral infarction sequelae group was higher than that in the hypertension with cerebral infarction group(P<0.05).Logistic multivariate regression analysis showed that drinking history,smoking history,infarct volume,NIHSS score,WBC,GLU,UA,CRP,IL-6,LDL-C,systolic blood pressure,diastolic blood pressure and FIB were independent risk factors affecting the prognosis of the patients with hypertension complicated with cerebral infarction sequelae(P<0.05).Conclusion Elderly hypertensive patients with sequelae of cerebral infarction have excessively high blood pressure and abnormal circadian rhythms.If they are combined with a history of drinking,smoking,and large infarct volume,as well as NIHSS scores,WBC,GLU,UA,CRP,IL-6,LDL-C,systolic blood pressure,diastolic blood pressure and high expression of FIB,their prognosis is poor.Therefore,clinical intervention should be carried out in time to reduce the poor prognosis.