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

    摘要
  • 摘要: 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%（χ2=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。

     

    Abstract: Objective To observe the trajectory of systolic blood pressure（SBP） during 24 hours after admission in patients with acute ischemic stroke（AIS） and its relationship with early prognosis. Methods A total of 319 patients with AIS who met the inclusion criteria and were hospitalized in Ward 2 and Ward 4, Department of Neurology, Affiliated Hospital of North China University of Science and Technology from June 2019 to January 2022 were selected. According to the change trend of SBP within 24 hours of admission, patients were divided into high-stable group（SBP≥160 mmHg within 24 hours）, high-medium group（SBP≥160 mmHg in the first 6 hours after admission and subsequently decreased to 140-160 mmHg or lower）, medium-stable group（SBP was 140-160 mmHg within 24 hours）, medium-low group（SBP was 140-160 mmHg in the first 6 hours after admission and subsequently decreased to ＜140 mmHg） and low-stable group（SBP ＜140 mmHg in 24 hours, but not lower than 120 mmHg）. The primary outcome was poor early prognosis modified Rankin scale（mRs） score ≥3 at 14 d of onset or at discharge. Multivariable logistic regression analysis was used to analyse the relationship between SBP trajectory and early prognosis. Results A total of 319 patients with AIS were included in this study, and five SBP trajectory groups were determined according to the SBP trend in 24 hours: high-stable group（50 cases, 15.7%）, high-medium group（101 cases, 31.7%）, medium-stable group（66 cases, 20.7%）, medium-low group（74 cases, 23.2%）, low-stable group（28 cases, 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-medium group, medium-stable group, medium-low group and low-stable group was 58.0%, 33.7%, 30.3%, 28.4% and 42.9%, respectively（χ~2=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 lipoprotein cholesterol, homocysteine, mean SBP in 24 hours, standard deviation（SD） of SBP in 24 hours, antihypertensive treatment. Conclusions The SBP trajectory within 24 hours after admission may be a predictor of early poor prognosis 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.

     

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