Rodríguez-Yáñez M, Castellanos M, Blanco M, García M M, Nombela F, Serena J, Leira R, Lizasoain I, Dávalos A, Castillo J
Department of Neurology, Stroke Unit, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain.
Neurology. 2006 Dec 12;67(11):1973-8. doi: 10.1212/01.wnl.0000247064.53130.91.
To study the association of previously unknown high blood pressure (HBP) during the acute phase of stroke (new-onset hypertension) with the inflammatory response and clinical outcome.
We classified 844 patients with hemispheric ischemic stroke into three groups according to history of hypertension and presence of HBP within the first 24 hours after symptom onset: Group I (n = 412), normotensive patients; Group II (n = 265), chronic hypertensive patients; and Group III (n = 167), new-onset hypertensive patients. Interleukin 6 (IL-6), tumor necrosis factor alpha (TNF-alpha), intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule 1 (VCAM-1), and metalloproteinase 9 (MMP-9) were measured in blood samples obtained on admission. The influence of new-onset HBP and markers of inflammation on poor neurologic outcome at 3 months was evaluated by logistic regression analysis.
New-onset HBP was found in 19.9% of patients. Patients in this group had higher plasma concentrations of IL-6, TNF-alpha, ICAM-1, VCAM-1, and MMP-9 than the other two groups. New-onset HBP was associated with poor outcome at 3 months (odds ratio [OR] 2.10; 95% CI 1.54 to 3.52; p < 0.0001) after adjustment for other prognostic factors. However, when markers of inflammation were included in the model, IL-6 (OR 1.01; 95% CI 1.00 to 1.03; p = 0.020) and MMP-9 (OR 1.01; 95% CI 1.00 to 1.01; p < 0.0001), but not new-onset HBP, were independently associated with poor neurologic outcome.
New-onset high blood pressure in acute ischemic stroke, but not chronic hypertension, is associated with an inflammatory response and poor neurologic outcome.
研究卒中急性期既往未知的高血压（新发高血压）与炎症反应及临床结局之间的关联。
我们根据高血压病史以及症状发作后24小时内高血压的存在情况，将844例半球缺血性卒中患者分为三组：第一组（n = 412），血压正常患者；第二组（n = 265），慢性高血压患者；第三组（n = 167），新发高血压患者。在入院时采集的血样中检测白细胞介素6（IL-6）、肿瘤坏死因子α（TNF-α）、细胞间黏附分子1（ICAM-1）、血管细胞黏附分子1（VCAM-1）和金属蛋白酶9（MMP-9）。通过逻辑回归分析评估新发高血压和炎症对3个月时不良神经结局的影响。
19.9%的患者发现有新发高血压。该组患者的血浆IL-6、TNF-α、ICAM-1、VCAM-1和MMP-9浓度高于其他两组。在调整其他预后因素后，新发高血压与3个月时的不良结局相关（比值比[OR] 2.10；95%可信区间1.54至3.52；p < 0.0001）。然而，当将炎症标志物纳入模型时，IL-6（OR 1.01；95%可信区间1.00至1.03；p = 0.020）和MMP-9（OR 1.01；95%可信区间1.00至1.01；p < 0.0001），而非新发高血压，与不良神经结局独立相关。
急性缺血性卒中时的新发高血压而非慢性高血压与炎症反应及不良神经结局相关。
