入院收缩压与脑梗死病因亚型的相关性

Correlation between systolic blood pressure at admission and etiological subtype of cerebral infarction

目的探讨脑梗死患者入院时收缩压与病因亚型的相关性。方法回顾性分析2015年1月-2018年3月连续入住四川大学华西医院的脑梗死患者资料。纳入发病24 h内患者,根据Org 10172急性卒中治疗试验病因分型,使用多因素无序多分类logistic回归分析入院时收缩压与病因亚型的相关性。结果共纳入符合条件者944例,占总登记病例数的37.3%(944/2528)。患者平均年龄(65.35±14.17)岁,男性543例(57.5%),发病到入院的中位时间为15 h,血压升高者516例(54.7%)。纳入患者中,大动脉粥样硬化型、小动脉闭塞型、心源性栓塞型、其他明确病因型及不明原因型分别为235例(24.9%)、200例(21.2%)、189例(20.0%)、17例(1.8%)、303例(32.1%)。多因素无序多分类logistic回归分析显示,入院时收缩压与心源性栓塞型呈负相关[比值比(odds ratio,OR)=0.987,95%置信区间(confidence interval,CI)(0.977,0.998)];以入院时收缩压分组为自变量纳入模型分析显示,收缩压正常[<140 mm Hg(1 mm Hg=0.133 kPa)]与心源性栓塞型呈正相关[OR=2.016,95%CI(1.211,3.357)];未发现其他病因亚型与入院时收缩压存在相关性。结论急性脑梗死入院时收缩压正常,则可能为心源性栓塞型病因。这将有助于临床医生于发病早期基于发病机制进行个体化的决策。

Objective To investigate the relationship between systolic blood pressure(SBP)and etiological subtype in patients with cerebral infarction.Methods Retrospective analysis was made on the data of patients with cerebral infarction admitted to West China Hospital of Sichuan University between January 2015 and March 2018.Patients within 24 h of symptom were included.Etiological subtypes were classified according to Trial of Org 10172 in Acute Stroke Treatment criteria.Multinomial logistic regression was used to analyze the correlation between SBP at admission and etiological subtype.Results A total of 944 eligible cases were included,accounting for 37.3%(944/2528)of the total number of registered cases.The mean age was(65.35±14.17)years,and 57.5%(543/944)were male.The median time from onset to admission was 15 h,with 54.7%(516/944)of patients having elevated blood pressure.Among the patients,large artery atherosclerosis,small artery occlusion,cardiogenic embolism,other definite causes and undetermined causes accounted for 24.9%(235 cases),21.2%(200 cases),20.0%(189 cases),1.8%(17 cases),and 32.1%(303 cases),respectively.Multinomial analysis showed that there was a significant negative correlation between SBP at admission and cardioembolic etiology[odds ratio(OR)=0.987,95%confidence interval(CI)(0.977,0.998)];normal SBP at admission[<140 mm Hg(1 mm Hg=0.133 kPa)]was significantly positively correlated with cardioembolic etiology[OR=2.016,95%CI(1.211,3.357)].Conclusion Normal SBP at admission with acute cerebral infarction predicts cardioembolic etiology,which will be helpful for clinicians to make individual decision based on the pathogenesis in the early stage.