妊娠期高血压综合征患者长期随访发生脑卒中风险分析

Risk analysis of cerebrovascular events in patients with hypertensive disorders of pregnancy in long-term follow-up

目的探讨并分析妊娠期高血压综合征(HDP)患者随访访5~8年发生脑血管事件的风险,并分析相关的危险因素。方法回顾性选取2013年1月至2016年12月在我院诊治的32孕周以上妊娠者,根据是否合并妊高症,分为HDP组(320例)和对照组(320例)。采集两组患者基线资料、入院后相关实验室指标及超声心动图指标,并对所有患者进行随访。随访截至2021年12月,主要观察脑血管事件,包括短暂性脑缺血发作、缺血性脑卒中、出血性脑卒中发生情况。采用Kaplan-Meier生存分析比较各组的脑血管事件发生风险,Cox回归分析评估发生脑血管事件的相关因素。结果与对照组比较,HDP组慢性高血压率更高(16.9%比2.8%,χ^(2)=21.347,P<0.001),收缩压(146.2 mmHg比118.5 mmHg,t=21.293,P<0.001)、舒张压(86.9 mmHg比80.3 mmHg,t=7.761,P<0.001)、血肌酐更高(62.1μmol/L比59.4μmol/L,t=4.346,P<0.001),而血红蛋白(118.5 g/L比120.1 g/L,t=2.013,P=0.045)更低。随访5~8年,共有28例脑血管事件病例,其中,HDP组和对照组发生脑血管事件分别为20例和8例,短暂性脑缺血发作、缺血性脑卒中、出血性脑卒中分别为11、6、3例和5、2、1例。Kaplan-Meier生存分析结果显示,HDP组的脑血管事件发生风险显著高于对照组(6.25%比2.50%,Log-rankχ^(2)=5.869,P=0.008)。此外,与对照组比较,HDP组的短暂性脑缺血发作(3.44%比1.56%,Log-rankχ^(2)=5.162,P=0.013)、缺血性脑卒中(1.89%比0.63%,Log-rankχ^(2)=4.016,P=0.022)和出血性脑卒中(0.94%比0.31%,Log-rankχ^(2)=3.508,P=0.037)的发生风险均明显增高(P<0.05)。多元Cox回归结果显示,HDP、妊娠糖尿病、高血脂以及收缩压、总胆固醇和血肌酐升高均是随访发生脑血管事件的危险因素(P<0.05)。不同HDP亚型中,慢性高血压并发子痫前期发生脑血管事件的风险最高(HR=1.705,P=0.019),其次为子痫前期/子痫(HR=1.573,P=0.005)、妊娠合并慢性高血压(HR=1.506,P=0.025)和妊娠期高血压(HR=1.482,P=0.002)。结论妊高症患者长期随访发生脑血管事件的风险显著增加,且慢性高血压与叠加的子痫前期亚型的发生风险最高。

Objective To explore and analyze the risk of cerebrovascular events in patients with hypertensive disorders of pregnancy(HDP)after 5-8 years of follow-up,and analyze the related risk factors.Methods Patients with more than 32 gestational weeks of pregnancy treated in our hospital from January 2013 to December 2016 were retrospectively selected,and divided into HDP group(320 cases)and control group(320 cases)according to whether they were complicated with HDP.The baseline data,relevant laboratory indexes and echocardiographic indexes of the two groups were collected,and all patients were follow up.Up to December 2021,the endpoint was the occurrence of cerebrovascular events,including transient ischemic attack,ischemic stroke,and hemorrhagic stroke.Kaplan Meier survival analysis was used to compare the risk of cerebrovascular events in each group,and Cox regression analysis was used to evaluate the related factors of cerebrovascular events.Results Compared with the control group,the HDP group was associated with increased rate of chronic hypertension(16.9%vs.2.8%,χ^(2)=21.347,P<0.001),higher levels of systolic blood pressure(146.2 mmHg vs.118.5 mmHg,t=21.293,P<0.001),diastolic blood pressure(86.9 mmHg vs.80.3 mmHg,t=7.761,P<0.001),and serum creatinine(62.1μmol/L vs.59.4μmol/L,t=4.346,P<0.001),and lower level of hemoglobin(118.5 g/L vs.120.1 g/L,t=2.013,P=0.045).During the follow-up of 5-8 years,there were 28 cases of cerebrovascular events,including 20 and 8 cases of cerebrovascular events,11 and 5 cases of transient ischemic attack,6 and 2 cases of ischemic stroke,3 and 1 cases of hemorrhagic stroke in HDP group and control group,respectively.Cerebrovascular events were mainly occurred after a median follow-up of 5(3,8)years after discharge.Kaplan Meier survival analysis showed that the risk of cerebrovascular events in the HDP group was significantly higher than that in the control group(6.25%vs.2.50%,log rankχ^(2)=5.869,P=0.008).In addition,compared with the control group,the risk of transient ischemic attack(3.44%vs.1.56%,log rankχ^(2)=5.162,P=0.013),ischemic stroke(1.89%vs.0.63%,log rankχ^(2)=4.016,P=0.022)and hemorrhagic stroke(0.94%vs.0.31%,log rankχ^(2)=3.508,P=0.037)were significantly higher in HDP group(P<0.05).Multiple Cox regression results showed that HDP,gestational diabetes mellitus,hyperlipidemia,high systolic blood pressure,high levels of total cholesterol and serum creatinine were the risk factors of cerebrovascular events(P<0.05).Among different HDP subtypes,the risk of cerebrovascular event was the highest in chronic hypertension complicated with preeclampsia(HR=1.705,P=0.019),followed by preeclampsia/eclampsia subgroup(HR=1.573,P=0.005),pregnancy complicated with chronic hypertension subgroup(HR=1.506,P=0.025),and gestational hypertension subgroup(HR=1.482,P=0.002).Conclusions The risk of cerebrovascular events in patients with HDP during long-term follow-up is significantly increased,which is the highest in those with chronic hypertension complicated with preeclampsia subtypes.