入院24 h收缩压轨迹与急性缺血性脑卒中早期预后的相关性

Association of 24-hour systolic blood pressure trajectory after admission and early prognosis in patients with acute ischemic stroke

目的 观察急性缺血性脑卒中患者入院后24 h收缩压轨迹及其与早期预后的关系。方法 选择2019年6月至2022年1月在华北理工大学附属医院神经内科二、四病区住院治疗的符合纳入标准的319例急性缺血性脑卒中患者,根据入院24 h内收缩压的变化趋势将患者分为高-稳定组(24 h收缩压持续≥160 mmHg),高-中组(入院后前6 h收缩压≥160 mmHg,随后收缩压下降至140~160 mmHg或更低),中-稳定组(24 h收缩压均在140~160 mmHg),中-低组(入院后前6 h收缩压位于140~160 mmHg,随后下降至<140 mmHg),低-稳定组(24 h收缩压均<140 mmHg,但不低于120 mmHg)。主要研究结果是早期预后不良[发病14 d或出院时改良Rankin量表(mRs)评分≥3分]。采用多因素logistic回归分析收缩压轨迹与早期预后的关系。结果 本研究共纳入急性缺血性脑卒中患者319例,根据其24 h收缩压变化趋势最终确定了5个收缩压轨迹组:高-稳定组50例(15.7%),高-中组101例(31.7%),中-稳定组66例(20.7%),中-低组74例(23.2%),低-稳定组28例(8.7%)。发病14 d后或出院时发生预后不良116例(36.4%),高-稳定组、高-中组、中-稳定组、中-低组、低-稳定组早期预后不良的比例分别是58.0%、33.7%、30.3%、28.4%、42.9%(χ^(2)=14.030,P=0.007)。多因素logistic回归分析结果显示,与高-稳定组相比,调整了性别、高血压病史、低密度脂蛋白胆固醇、同型半胱氨酸、24 h收缩压平均值、24 h收缩压标准差、降压治疗等因素后,高-中组、中-稳定组、中-低组发生早期预后不良的风险降低,调整后的OR(95%CI)分别为0.144(0.048~0.431),0.226(0.057~0.902),0.131(0.022~0.769)。结论 急性缺血性脑卒中入院后24 h内收缩压轨迹可能是脑卒中早期预后不良的预测因素。急性期收缩压下降并维持于120~160 mmHg可能预示着早期预后不良风险降低。

Objective To observe the trajectory of systolic blood pressure(SBP)during 24hours after admission in patients with acute ischemic stroke(AIS)and its relationship with early prognosis.Methods A total of 319pa-tients with AIS who met the inclusion criteria and were hospitalized in Ward 2and Ward 4,Department of Neurolo-gy,Affiliated Hospital of North China University of Science and Technology from June 2019to January 2022were selected.According to the change trend of SBP within 24hours of admission,patients were divided into high-stable group(SBP≥160mmHg within 24hours),high-medium group(SBP≥160mmHg in the first 6hours after admis-sion and subsequently decreased to 140-160mmHg or lower),medium-stable group(SBP was 140-160mmHg within 24hours),medium-low group(SBP was 140-160mmHg in the first 6hours after admission and subsequent-ly decreased to<140mmHg)and low-stable group(SBP<140 mmHg in 24 hours,but not lower than 120mmHg).The primary outcome was poor early prognosis[modified Rankin scale(mRs)score≥3at 14dof on-set or at discharge].Multivariable logistic regression analysis was used to analyse the relationship between SBP traj-ectory and early prognosis.Results A total of 319patients with AIS were included in this study,and five SBP rajectory groups were determined according to the SBP trend in 24hours:high-stable group(50cases,15.7%),high-medium group(101cases,31.7%),medium-stable group(66cases,20.7%),medium-low group(74cases,23.2%),low-stable group(28cases,8.7%).One hundred and sixteen patients(36.4%)had poor prognosis at 14 days after onset or at the time of discharge.The proportion of early poor prognosis in high-stable group,high-medi-um group,medium-stable group,medium-low group and low-stable group was 58.0%,33.7%,30.3%,28.4%and 42.9%,respectively(χ2=14.030,P=0.007).The results of multivariable logistic regression analysis showed that compared with the high-stable group,the high-medium group,the medium-stable group and the medium-low group had a reduced risk of poor early prognosis,with OR(95%CI)of 0.144(0.048-0.431),0.226(0.057-0.902),0.131(0.022-0.769),respectively,after adjusting for sex,history of hypertension,low density lipopro-tein cholesterol,homocysteine,mean SBP in 24hours,standard deviation(SD)of SBP in 24hours,antihypertensive treatment.Conclusions The SBP trajectory within 24hours after admission may be a predictor of early poor prog-nosis for acute ischemic stroke.A decrease in systolic blood pressure in the acute phase and maintenance at 120-160 mmHg may indicate a reduced risk of poor early prognosis.