不同TOAST分型的缺血性卒中急性期高血压的特点及其对预后的影响

摘要

Objective To clarify the change in high blood pressure(BP) and its relation with prognosis of acuteischemic stroke with no antihypertensive therapy.Methods Consecutive patients who were hospitalized within 48 hours and were diagnosed as acuteischemic stroke were registered prospectively. All patients were divided into four groups refer to theimproved Trial of OrgK)172 in Acute Stroke Treatment(TOAST) criteria of ischemic stroke type.To study the BP levels during the initial 14 hospital days. Death and dependency were assessed at3 months. Relationship between BP in different time periods and death/dependency rate of threemonth was analyzed. Spearman's correlation analysis was used to analyze factors relations to death/independent rate.Results The systolic blood pressure(SBP) and diastolic blood pressure(DBP) course anddecrease in mean BP in patients of these four groups have no significant differences. This best BPin patients of these four groups has not significant difference. And the correlation of the averageof BP and death/dependency rate of three month was not statistically different. However the riskfactors relations to death/independent rate at 3 months after onset were different, SBP decreasedwithin 24 hours of admission were significantly associated with death/dependency rate at 3months after onset in atherosclerosis type and cardioembolism type.Conclusions BP change in different causes of acute ischemic stroke are almost no statisticaldifferent. SBP decreased within 24 hours of admission were significantly associated with death/dependency rate at 3 months after onset in atherosclerosis type and cardioembolism type.%目的 探讨不同病因缺血性卒中急性期未予降压干预的高血压变化特点及对预后的影响.方法 前瞻性的连续登记发病48小时内被诊断为缺血性卒中的患者,参照改良急性卒中治疗Orgl0172试验(Trial of Org10172 in Acute Stroke Treatment,TOAST)分型标准,将入选患者分为4组,动态监测入院14天内的血压变化,盲法随访发病后3个月的死亡、残疾情况,采用Spearman相关分析法分析影响各组患者发病后3个月死亡/残疾率的因素.结果 4组患者的平均收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)以及平均SBP、DBP随时间变化的趋势和平均血压下降幅度差异无显著性；4组患者入院4～14天内各相同时间段平均血压的最佳临界值无差异,且平均血压与发病3个月后死亡/残疾率的相关性差异无显著性；然而不同病因缺血性卒中惠者发病后3个月死亡/残疾率的影响因素各不相同,24小时内SBP下降幅度与动脉粥样硬化血栓形成型、心源性拴塞型患者发病3个月的死亡/残疾率显著相关(P=0.048,P=0.045).结论 不同病因缺血性卒中急性期血压变化规律并无明显差异.入院24小时内SBP降压过快可能增加动脉粥样硬化血栓形成型及心源性栓塞型患者3个月后的死亡/残疾率.