基底节区高血压脑出血患者血压控制水平、长时血压变异性及血清IL-6对早期认知障碍的影响

Influences of blood pressure control,long-term blood pressure variability and serum IL-6 in early cognitive impairment in patients with basal ganglia hypertensive intracerebral hemorrhage

目的探讨基底节区高血压脑出血(HICH)患者血压波动及生化指标对其早期发生认知障碍的影响。方法选择苏州大学附属第二医院神经外科自2022年1月至2024年1月收治的148例基底节区HICH患者,发病4周后采用蒙特利尔认知评估(MoCA)量表评定患者的认知功能,将患者分为认知障碍组(MoCA评分<26分,62例)和非认知障碍组(MoCA评分≥26分,86例)。收集2组患者的临床资料及入院后连续7 d的平均血压,比较2组患者间临床资料、平均收缩压(MSBP)、平均舒张压(MDBP)及长时血压变异性指标的差异。采用多因素Logistic回归分析筛选基底节区HICH患者发生认知障碍的独立影响因素。采用Spearman秩相关分析检验基底节区HICH患者认知障碍的独立影响因素与MoCA评分的相关性。采用受试者工作特征(ROC)曲线分析各独立影响因素对基底节区HICH患者认知障碍的诊断价值。结果与非认知障碍组比较,认知障碍组患者的高血压病程较长、白细胞介素-6(IL-6)水平较高、白蛋白水平较低,差异均有统计学意义(P<0.05)。与非认知障碍组相比,认知障碍组患者的MSBP、MDBP、7 d收缩压标准差(7dSSD)较高,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,高血压病程(OR=1.258,95%CI:1.134~1.396,P<0.001)、MSBP(OR=1.770,95%CI:1.267~2.473,P=0.001)、7dSSD(OR=1.139,95%CI:1.038~1.249,P=0.006)、IL-6(OR=1.156,95%CI:1.076~1.241,P<0.001)是基底节区HICH患者发生认知障碍的独立影响因素。Spearman秩相关分析显示,基底节区HICH患者的高血压病程、MSBP、7dSSD、IL-6与MoCA量表评分均呈负相关关系(rs=-0.271,P=0.001;rs=-0.493,P<0.001;rs=-0.264,P=0.001;rs=-0.412,P<0.001)。ROC曲线分析显示,联合应用MSBP、7dSSD、IL-6、高血压病程诊断基底节区HICH患者早期发生认知障碍的AUC为0.932,敏感度为0.855,特异度为0.895。结论MSBP、7dSSD、高血压病程及血清IL-6可能为基底节区HICH患者早期认知障碍的血流动力学及血清学监测指标。

ObjectiveTo investigate the influences of blood pressure fluctuation and biochemical parameters in early cognitive impairment in patients with basal ganglia hypertensive intracerebral hemorrhage(HICH).MethodsA total of 148 patients with basal ganglia HICH,admitted to Department of Neurosurgery,Second Affiliated Hospital of Soochow University from January 2022 to January 2024 were enrolled.Four weeks after onset,these patients accepted Montreal cognitive assessment(MoCA)and were divided into cognitive impairment group(MoCA scores<26,n=62)and non-cognitive impairment group(MoCA scores≥26,n=86)accordingly.Clinical data and average blood pressure on 7 consecutive d(since admission)were collected,and differences of clinical data,mean systolic blood pressure(MSBP),mean diastolic blood pressure(MDBP),and long-term blood pressure variability indexes were compared between the two groups.Multivariate Logistic regression analysis was used to screen the independent influencing factors for cognitive impairment;spearman rank correlation was used to analyze the correlation between independent influencing factors and MoCA score;and receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of independent influencing factors in cognitive impairment.ResultsCompared with the non-cognitive impairment group,the cognitive impairment group had significantly longer hypertension duration,statistically higher interleukin-6(IL-6),MSBP,MDBP and 7 d-duration standard deviation of systolic blood pressure(7dSSD),and significantly lower albumin(P<0.05).Multivariate Logistic regression analysis showed that hypertension duration(OR=1.258,95%CI:1.134-1.396,P<0.001),MSBP(OR=1.770,95%CI:1.267-2.473,P=0.001),7dSSD(OR=1.139,95%CI:1.038-1.249,P=0.006),and IL-6(OR=1.156,95%CI:1.076-1.241,P<0.001)were independent influencing factors for early cognitive impairment in patients with basal ganglia HICH.Spearman rank correlation showed that hypertension duration,MSBP,7DSSD,and IL-6 were negatively correlated with MoCA score(r s=-0.271,P=0.001;r s=-0.493,P<0.001;r s=-0.264,P=0.001;r s=-0.412,P<0.001).Area under ROC curve of combined use of MSBP,7dSSD,hypertension duration and IL-6 in diagnosing early cognitive impairment was 0.932,with sensitivity of 0.855 and specificity of 0.895.ConclusionMSBP,7dSSD,hypertension duration and IL-6 might be hemodynamic and serological monitoring indexes for predicting early cognitive impairment in patients with basal ganglia HICH.