清晨高血压等相关危险因素与缺血性脑卒中复发的关系

Relationship between recurrence of ischemic stroke and morning hypertension and other risk factors

目的探讨清晨高血压等相关危险因素与缺血性脑卒中复发的关系。方法纳入急性缺血性脑卒中患者702例,随访1年,将106例复发患者作为复发组,在586例未复发的患者中抽取与复发患者性别、年龄相匹配的212例作为未复发组。采用χ~2检验分析清晨高血压、抗栓治疗依从性、他汀类药物依从性与缺血性脑卒中复发的关系;将差异有统计学意义的因素代入二元logistic回归方程,判断其是否为缺血性脑卒中复发的独立危险因素。采用χ~2检验比较不同类肝素药物治疗急性缺血性脑卒中试验(TOAST)分型的患者脑卒中复发率的差异。结果缺血性脑卒中复发的独立危险因素有清晨高血压(OR=3.140,P<0.01)、血脂异常(OR=2.242,P<0.01)、颈动脉易损斑块(OR=1.932,P<0.01)、心房颤动(OR=1.827,P<0.05),保护因素有抗栓治疗依从(OR=0.451,P<0.01)和他汀类药物依从(OR=0.528,P<0.05)。复发组TOAST分型中大动脉粥样硬化型和心源性栓塞型的患者比例均显著高于未复发组(P值分别<0.01、0.05)。结论加强对清晨高血压,以及其他相关危险因素如血脂异常、心房颤动、颈动脉易损斑块的管理,提高抗栓治疗和他汀类药物依从性或可减少缺血性脑卒中复发风险。

Objective To investigate the relationship between risk factors(such as morning hypertension)and recurrence of ischemic stroke.Methods A total of 702 patients with acute ischemic stroke were followed up for one year.Of them,106 patients with recurrence were selected as study group,and 212 patients matched with sex and age were selected from 586 patients without recurrence as control group.Univariate analysis was used to investigate the relationship between risk factors(such as morning hypertension,antithrombotic compliance,statins compliance and other related factors)and ischemic stroke recurrence.The univariate logistic regression equation was used to determine whether they were the independent risk factors for cerebral infarction recurrence.The relationship between different trial of Org 10 172 in actue stroke treatment(TOAST)classification and recurrence was investigated.Results Morning hypertension(OR=3.140,P<0.01),dyslipidemia(OR=2.242,P<0.01),carotid vulnerable plaque(OR=1.932,P<0.01)and atrial fibrillation(OR=1.827,P<0.05)were independent risk factors of the recurrence of ischemic stroke,while antithrombotic compliance(OR=0.451,P<0.01)and statin compliance(OR=0.528,P<0.05)were protective factors.In TOAST classification,patients with large arterial atherosclerosis(LAA)and cardiogenic embolism(CE)were prone to have a relapse.Conclusion Recurrence risk of ischemic stroke may be reduced by strengthening the management of morning hypertension and other risk factors such as dyslipidemia,atrial fibrillation,carotid vulnerable plaques,and increasing antithrombotic and statin compliance.