血压昼夜节律异常与老年轻型卒中早期进展的关系

发布时间：2018-06-30 02:52

本文选题：卒中 + 轻型　；参考：《中国脑血管病杂志》2017年07期

【摘要】：目的探讨老年轻型卒中患者早期病情进展与血压昼夜节律异常的关系。方法回顾性连续纳入2013年6月至2016年12月北京市中关村医院神经内科年龄65岁轻型卒中[美国国立卫生卒中研究院量表评分(3分)]患者180例,根据患者是否发生早期(发病5 d内)神经功能恶化分为进展组48例(美国国立卫生卒中研究院量表评分增加≥2分)和非进展组(132例)。比较两组患者的基线资料、脑血管病危险因素(高血压病、糖尿病、卒中、长期吸烟、饮酒、高脂血症、高同型半胱氨酸)的差异。动态血压监测的血压昼夜节律为正常(勺型血压)、异常(非勺型血压、超勺型血压、反勺型血压)。责任动脉分为重度狭窄及闭塞、非重度狭窄或无狭窄。对两组分类变量进行单因素分析,并进一步行多因素Logistic回归分析及多分类哑变量分析。结果进展组患者既往糖尿病病史、卒中病史、血压节律异常、责任动脉重度狭窄及闭塞比例均高于非进展组,分别为[70.8%(34例)比49.2%(65例)、64.6%(31例)比47.7%(63例)、89.6%(43例)比26.5%(35例)、77.1%(37例)比39.4%(52例)],差异均有统计学意义(均P㩳0.05)。将差异有统计学意义因素代入多因素Logistic回归分析,显示血压昼夜节律异常(OR=7.072,95%CI:3.004~16.431,P0.01)及责任动脉重度狭窄或闭塞(OR=6.217,95%CI:2.034~14.212,P=0.003)为老年轻型卒中早期进展的独立危险因素;对血压节律异常行哑变量分析显示,血压昼夜异常中超勺型血压(OR=13.429,95%CI:4.175~111.668,P0.01)为老年轻型卒中早期进展的独立危险因素。结论血压昼夜节律异常,尤其是超勺型血压可能为老年轻型卒中早期病情进展的独立危险因素,需要密切关注,尽早干预。
[Abstract]:Objective to investigate the relationship between the early progression and abnormal circadian rhythm of blood pressure in elderly patients with mild stroke. Methods from June 2013 to December 2016, 180 patients with mild stroke, aged 65 years, were enrolled in the Department of Neurology, Zhongguancun Hospital, Beijing from June 2013 to December 2016 [National Institutes of Health Stroke scale score (3 points)]. According to whether the patients had early neurological deterioration (within 5 days of onset), they were divided into progressive group (48 cases) and non-progressive group (132 cases). The baseline data and risk factors of cerebrovascular disease (hypertension, diabetes, stroke, long-term smoking, alcohol consumption, hyperlipidemia, hyperhomocysteine) were compared between the two groups. The circadian rhythm of ambulatory blood pressure monitoring was normal (dipper blood pressure), abnormal (non dipper blood pressure, super dipper blood pressure, reverse dipper blood pressure). The responsible arteries were divided into severe stenosis and occlusion, non-severe stenosis or no stenosis. Two groups of classified variables were analyzed by univariate analysis and multivariate logistic regression analysis and mute variable analysis. Results the history of diabetes, stroke, abnormal blood pressure rhythm, the proportion of severe stenosis and occlusion of the responsible artery in the progressive group were higher than those in the non-progressive group. It was [70.8% (34 cases) vs 49.2% (65 cases), 64.6% (31 cases) vs 47.7% (63 cases), 89.6% (43 cases) vs 26.5% (35 cases), 77.1% (37 cases) vs 39.4% (52 cases)]. The multivariate logistic regression analysis showed that abnormal circadian rhythm of blood pressure (OR 7.072n 95 CI: 3.004 ~ 16.431) and severe stenosis or occlusion of responsible artery (OR6.217 95 CI: 2.034 ~ 14.212P0. 003) were independent risk factors for early progression of mild stroke in the elderly. The analysis of mute variables of abnormal blood pressure rhythm showed that the hyperdipper blood pressure (ORO 13.42995 CI: 4.175111.668 P0.01) was an independent risk factor for the early progression of mild stroke in the elderly. Conclusion abnormal circadian rhythm of blood pressure, especially hyper dipper blood pressure, may be an independent risk factor for the early progression of mild stroke in the elderly, so it is necessary to pay close attention to it and intervene as soon as possible.
【作者单位】：北京市中关村医院神经内科;
【分类号】：R743.3

【相似文献】