动态血压监测血压变异性在急性脑梗死溶栓治疗预后评估中的应用

Application of ambulatory blood pressure monitoring blood pressure variability in the evaluation of prognosis in patients with acute cerebral infarction after thrombolytic therapy

目的探讨24 h动态血压监测血压变异性在急性脑梗死溶栓治疗患者预后评估中的应用价值。方法前瞻性纳入广西科技大学第一附属医院2018-01—2020-12接受溶栓治疗的80例急性脑梗死患者为研究对象,采用美国国立卫生研究院卒中量表(NIHSS)评估患者预后并分组。所有患者均接受24 h动态血压监测,检测患者溶栓治疗时血压变异性(24 h收缩压变异系数、24 h舒张压变异系数),采集患者相关基线资料,分析24 h动态血压监测血压变异性与急性脑梗死溶栓治疗患者预后的关系。结果80例急性脑梗死患者溶栓后12例预后不良,发生率为15.00%。预后不良急性脑梗死患者胱抑素C(Cys C)[1.12(1.02,1.21)]、24 h收缩压变异系数[10.25(9.65,11.24)]、24 h舒张压变异系数[17.53(16.39,18.52)]均高于预后良好患者[1.02(1.02,1.03)]、[7.75(7.48,8.59)]、[13.38(12.64,13.89)](P<0.05),组间其他基线资料比较无显著差异(P>0.05)。经二元Logistic回归分析后建立多元回归模型,结果显示,24 h收缩压变异系数(P=0.003,OR=268.987,95%CI:6.607~10951.970)、24 h舒张压变异系数(P=0.001,OR=5.342,95%CI:1.954~14.605)异常升高可能是急性脑梗死患者溶栓预后不良的风险因子(OR>1,P<0.05)。绘制ROC曲线发现,当24 h收缩压变异系数、24 h舒张压变异系数cut-off值分别取8.405%、15.225%时,二者单一及联合检测预测急性脑梗死患者溶栓预后不良风险价值的AUC均>0.80,均有一定预测价值(AUC:0.893、0.870、0.924,95%CI:0.822~0.963、0.779~0.961、0.856~0.992,P<0.001,特异性:0.667、0.750、0.533,敏感度:0.950、0.950、0.950,约登指数:0.617、0.700、0.483),联合预测价值最高。结论急性脑梗死溶栓治疗患者有较高的预后不良风险,可能与患者24 h收缩压变异系数、24 h舒张压变异系数升高有关,考虑未来行24 h动态血压监测患者血压变异性,评估预后不良风险。

Objective To investigate the application value of 24-hour ambulatory blood pressure variability(BPV) in the evaluation of prognosis in patients with acute cerebral infarction after thrombolytic therapy.MethodsEighty patients with acute cerebral infarction who received thrombolytic therapy in the First Affiliated Hospital of Guangxi University of Science and Technology from January 2018 to December 2020 were prospectively included as the research subjects,National Institutes of Health stroke scale(NIHSS)was used to evaluate the prognosis of the patients.All patients received 24-hour ambulatory blood pressure monitoring,blood pressure variability(24-hour systolic blood pressure variation coefficient,24-hour diastolic blood pressure variation coefficient)of patients at the time of thrombolytic therapy were detected.The baseline data of patients were collected.The relationship between 24-hour ambulatory blood pressure monitoring blood pressure variability and the prognosis of patients with acute cerebral infarction after thrombolytic therapy was analyzed.Results Among 80 acute cerebral infarction patients after thrombolysis,the incidence was 15.00%.The expressions of cystatin(Cys C)(1.12(1.02,1.21)),24-hour systolic blood pressure variation coefficient(10.25(9.65,11.24))and 24-hour diastolic blood pressure variation coefficient(17.53(16.39,18.52))in patients with acute cerebral infarction who had poor prognosis were higher than those in patients who had good prognosis(1.02(1.02,1.03)),(7.75(7.48,8.59)),(13.38(12.64,13.89))(P<0.05).There was no difference in comparison other baseline data between two groups(P>0.05).After binary Logistic regression analysis,multiple regression model was established,the results showed that the abnormal increase of 24-hour systolic blood pressure variation coefficient(P=0.003,OR=268.987,95% CI:6.607~10 951.970)and 24-hour diastolic blood pressure variation coefficient(P=0.001,OR=5.342,95% CI:1.954~14.605)might be the risk factors of poor prognosis in patients with acute cerebral infarction after thrombolysis(OR>1,P<0.05).ROC curve was drawn and showed that when the cut-off values of 24-hour systolic blood pressure variation coefficient and 24-hour diastolic blood pressure variation coefficient,respectively,the AUC of single and combined detection to predict the adverse risk value of poor prognosis in patients with acute cerebral infarction after thrombolysis were all >0.80,which had certain predictive value(AUC:0.893,0.870,0.924;95% CI:0.822~0.963,0.779~0.961,0.856~0.992,P<0.001;specificity:0.667,0.750,0.533;sensitivity:0.950,0.950;Youden index:0.617,0.700,0.483),the value of joint prediction was the highest.ConclusionPatients with acute cerebral infarction after thrombolytic therapy have a higher risk of poor prognosis,which may be related to the increase of 24-hour systolic blood pressure variation coefficient and24-hour diastolic blood pressure variation coefficient of patients,considering to perform 24-hour ambulatory blood pressure in monitoring blood pressure variability of patients in the future,auxiliary assessing the risk of poor prognosis,which may have positive significance for early reasonable intervention and improving the prognosis of patients.