缺血性卒中急性期血压与预后初探
复旦大学华山医院神经科 (200040)
【摘要】背景：血压与卒中关系密切，大量研究已证实高血压是卒中的危险因素，降压治疗可降低急性缺血性卒中(Acute Ischemic Stroke,AIS)首发[1]及再发[2]概率，但AIS急性期血压水平与预后关系，至今仍未明确。虽然多数研究提示两者相关，但具体观点不同：①急性期血压水平高，预后好[4-6]；②急性期血压越高，预后越差；③急性期血压水平与预后存在U型关系，即血压过高、过低都影响预后，存在相对最适水平。当然也有部分研究认为两者并无关系。目的：初步探索缺血性卒中(AIS)急性期血压水平异常与预后关系。资料与方法：系回顾性队列研究，采用225例上海市医学发展基金重点项目“卒中规范化多中心治疗”抗凝治疗及其对照组中完成起病3月后随访的患者，均确诊为颈动脉系统AIS。收集患者起病48 h内随机血压水平，并随访近、远期预后。结果：单因素分析AIS急性期高收缩压(SBP)(OR 1.027，1.001～1.054，P=0.040)、高舒张压(DBP)(OR 1.044，1.002～1.087，P=0.038)近期预后差，但多因素分析均非独立近期预后因素；AIS急性期SBP系独立远期预后因素，与远期预后呈U型关系，即存在最适水平141～150mmHg，低于或高于此水平远期预后均差(分别为OR 5.803，1.440～23.381，P=0.013和OR 7.491，2.074～27.052，P=0.002)；急性期DBP与远期预后无关。结论：AIS急性期高血压有近期预后差的趋势，是否为独立预后因素尚不能肯定；急性期DBP水平与远期预后无关，但SBP系独立远期预后因素，存在最适水平(141～150mmHg)，过低或过高均致远期预后差。
, 百拇医药
【关键词】血压 缺血性卒中 预后
Blood pressure and clinical outcomes in acute ischemic stroke
DONG Qiang
Dept. of Neurology, Hua Shan Hospital, Fu Dan University
【Abstract】Objective: To explore the association of systolic (SBP) and diastolic (DBP) BP during acute ischemic stroke with subsequent clinical outcomes. Methods: The data including 225 patients from the Shanghai Stroke Trial (anticoagulant/control group) with confirmed acute anterior circulation ischemic stroke and fulfillment of follow-up was analyzed. A single casual SBP/DBP was recorded within 48 hours of stroke onset, before any dehydrator was administered. Potential prognostic factors were checked. Clinical outcomes were evaluated: (1) death resulting from any cause within 14 days; (2) death or dependency (BI 0～55) at 3 months. Result: 84% (189/225) of patients had high BP during the acute phase of ischemic stroke, if the JNC-7 definition of hypertension was used. In univariate analysis, hypertension known prior to stroke was associated with high SBP (P<0.0001) and high DBP (P<0.0001); conversely, age was related to low DBP (P=0.006). The relationship between high SBP (OR1.027,1.001～1.054, P=0.040), high DBP (OR1.044,1.002～1.087,P=0.038) and early death was observed in the uni- but not in the multivariate analysis. The lowest frequency of death or dependency at 3 months occurred in patients with a SBP of 141～150mmHg. And if this level was used as a reference point, both low (OR5.803,1.440～23.381,P=0.013) and high (OR7.491, 2.074～27.052, P=0.002) SBP increased the risk of poor late outcome. The multivariate regression analysis showed that this U-shaped relationship was independent. No association of DBP during acute stroke and late outcome was seen. Conclusion: High BP was common in acute ischemic stroke. The link between high BP during the acute period and poor early outcome was confirmed, but whether this was independent was unclear. DBP was not associated with late prognosis. However, both high (≤140mmHg) and low (>150mmHg) SBP were confirmed as independent late prognostic factors.
, 百拇医药
【Key words】 blood pressure; stroke,ischemic; prognosis
Serum level of homocysteine is correlated to carotid artery atherosclerosis in Chinese with ischemic stroke
FAN Dongsheng , WANG Hongli , SHEN Yang , ZHANG Hui, FU Yu .
Department of Neurology, Peking University Third Hospital, Beijing 100083, China
To investigate the relationship between serum level of homocysteine (Hcy) and carotid artery atheroscleosis (CAA). Both sides of the common carotid artery and internal carotid artery in one hundred and twenty-six cases of Chinese patients with ischemic stroke were measured by B–mode ultrasound, whom were divided into a normal group and A, B, C, D groups according to the severity of CAAs. With fasting serum, Hcy as well as folate, vitamin B12, and lipids were detected. The mean ± SD age was 64±13 years (range 39～87 years). In a logistic regression model, the Hcy concentrations were associated with an elevated risk of CAAs independent of all traditional risk factor. When CAAs became severer, the serum Hcy was higher. The levels of the normal group and A, B, C, D groups were 13.22±6.15 µmol/L, 16.29±9.81 µmol/L, 19.49±11.16 µmol/L, 27.21±17.47 µmol/L, 24.14±8.64 µmol/L, respectively. Rank test showed a significant difference between control and other groups (P<0.05). The levels of folate and vitamin B12 were negatively correlated with the Hcy concentrations. Spearman correlation coefficient are -0.23 and -0.42 (P<0.05). Hyperhomocysteinaemia is an independent risk factor of CAAs and the degree of CAAs is highly correlated with serum level of Hcy. The causes of hyperhomocysteinemia may be the result from decrease of folate and vitamin B12. Clinical trials are now required to evaluate the effect of treatment with these vitamins in the primary and secondary prevention of cerebral vascular diseases., http://www.100md.com(董强)
【摘要】背景：血压与卒中关系密切，大量研究已证实高血压是卒中的危险因素，降压治疗可降低急性缺血性卒中(Acute Ischemic Stroke,AIS)首发[1]及再发[2]概率，但AIS急性期血压水平与预后关系，至今仍未明确。虽然多数研究提示两者相关，但具体观点不同：①急性期血压水平高，预后好[4-6]；②急性期血压越高，预后越差；③急性期血压水平与预后存在U型关系，即血压过高、过低都影响预后，存在相对最适水平。当然也有部分研究认为两者并无关系。目的：初步探索缺血性卒中(AIS)急性期血压水平异常与预后关系。资料与方法：系回顾性队列研究，采用225例上海市医学发展基金重点项目“卒中规范化多中心治疗”抗凝治疗及其对照组中完成起病3月后随访的患者，均确诊为颈动脉系统AIS。收集患者起病48 h内随机血压水平，并随访近、远期预后。结果：单因素分析AIS急性期高收缩压(SBP)(OR 1.027，1.001～1.054，P=0.040)、高舒张压(DBP)(OR 1.044，1.002～1.087，P=0.038)近期预后差，但多因素分析均非独立近期预后因素；AIS急性期SBP系独立远期预后因素，与远期预后呈U型关系，即存在最适水平141～150mmHg，低于或高于此水平远期预后均差(分别为OR 5.803，1.440～23.381，P=0.013和OR 7.491，2.074～27.052，P=0.002)；急性期DBP与远期预后无关。结论：AIS急性期高血压有近期预后差的趋势，是否为独立预后因素尚不能肯定；急性期DBP水平与远期预后无关，但SBP系独立远期预后因素，存在最适水平(141～150mmHg)，过低或过高均致远期预后差。
, 百拇医药
【关键词】血压 缺血性卒中 预后
Blood pressure and clinical outcomes in acute ischemic stroke
DONG Qiang
Dept. of Neurology, Hua Shan Hospital, Fu Dan University
【Abstract】Objective: To explore the association of systolic (SBP) and diastolic (DBP) BP during acute ischemic stroke with subsequent clinical outcomes. Methods: The data including 225 patients from the Shanghai Stroke Trial (anticoagulant/control group) with confirmed acute anterior circulation ischemic stroke and fulfillment of follow-up was analyzed. A single casual SBP/DBP was recorded within 48 hours of stroke onset, before any dehydrator was administered. Potential prognostic factors were checked. Clinical outcomes were evaluated: (1) death resulting from any cause within 14 days; (2) death or dependency (BI 0～55) at 3 months. Result: 84% (189/225) of patients had high BP during the acute phase of ischemic stroke, if the JNC-7 definition of hypertension was used. In univariate analysis, hypertension known prior to stroke was associated with high SBP (P<0.0001) and high DBP (P<0.0001); conversely, age was related to low DBP (P=0.006). The relationship between high SBP (OR1.027,1.001～1.054, P=0.040), high DBP (OR1.044,1.002～1.087,P=0.038) and early death was observed in the uni- but not in the multivariate analysis. The lowest frequency of death or dependency at 3 months occurred in patients with a SBP of 141～150mmHg. And if this level was used as a reference point, both low (OR5.803,1.440～23.381,P=0.013) and high (OR7.491, 2.074～27.052, P=0.002) SBP increased the risk of poor late outcome. The multivariate regression analysis showed that this U-shaped relationship was independent. No association of DBP during acute stroke and late outcome was seen. Conclusion: High BP was common in acute ischemic stroke. The link between high BP during the acute period and poor early outcome was confirmed, but whether this was independent was unclear. DBP was not associated with late prognosis. However, both high (≤140mmHg) and low (>150mmHg) SBP were confirmed as independent late prognostic factors.
, 百拇医药
【Key words】 blood pressure; stroke,ischemic; prognosis
Serum level of homocysteine is correlated to carotid artery atherosclerosis in Chinese with ischemic stroke
FAN Dongsheng , WANG Hongli , SHEN Yang , ZHANG Hui, FU Yu .
Department of Neurology, Peking University Third Hospital, Beijing 100083, China
To investigate the relationship between serum level of homocysteine (Hcy) and carotid artery atheroscleosis (CAA). Both sides of the common carotid artery and internal carotid artery in one hundred and twenty-six cases of Chinese patients with ischemic stroke were measured by B–mode ultrasound, whom were divided into a normal group and A, B, C, D groups according to the severity of CAAs. With fasting serum, Hcy as well as folate, vitamin B12, and lipids were detected. The mean ± SD age was 64±13 years (range 39～87 years). In a logistic regression model, the Hcy concentrations were associated with an elevated risk of CAAs independent of all traditional risk factor. When CAAs became severer, the serum Hcy was higher. The levels of the normal group and A, B, C, D groups were 13.22±6.15 µmol/L, 16.29±9.81 µmol/L, 19.49±11.16 µmol/L, 27.21±17.47 µmol/L, 24.14±8.64 µmol/L, respectively. Rank test showed a significant difference between control and other groups (P<0.05). The levels of folate and vitamin B12 were negatively correlated with the Hcy concentrations. Spearman correlation coefficient are -0.23 and -0.42 (P<0.05). Hyperhomocysteinaemia is an independent risk factor of CAAs and the degree of CAAs is highly correlated with serum level of Hcy. The causes of hyperhomocysteinemia may be the result from decrease of folate and vitamin B12. Clinical trials are now required to evaluate the effect of treatment with these vitamins in the primary and secondary prevention of cerebral vascular diseases., http://www.100md.com(董强)