Lattanzi Simona, Cagnetti Claudia, Provinciali Leandro, Silvestrini Mauro
Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
J Stroke Cerebrovasc Dis. 2015 Jul;24(7):1493-9. doi: 10.1016/j.jstrokecerebrovasdis.2015.03.014. Epub 2015 Apr 11.
The aim of this study was to evaluate whether fluctuations of blood pressure (BP) levels occurring in the acute stage of spontaneous intracerebral hemorrhage (ICH) affect the 3-month clinical outcome.
We retrospectively identified consecutive patients hospitalized for acute spontaneous ICH. BP measurements over the first 72 hours from the onset of symptoms were recorded, and standard deviation (SD), coefficient of variation (CV), and maximum-minimum difference (max-min) were determined to characterize both systolic and diastolic BP variability (BPV). The measure of outcome was the 3-month functional status assessed by the modified Rankin Scale following a baseline severity-adjusted analysis.
Among the 138 enrolled patients with ICH, 67 (48.6%) were classified as having a poor 3-month functional recovery. A dose-response relationship with poor outcome was found for each measure of systolic BPV--adjusted odds ratios (ORs) for the highest thirds of SD 7.95 (95% confidence interval [CI], 2.88-21.90), CV 7.74 (95% CI, 2.88-20.80), and max-min 8.36 (95% CI, 2.72-25.62; P < .001). The strength of association with diastolic BPV turned out to be weaker and significant only for the higher values (adjusted ORs for the highest thirds of SD 6.74 [95% CI, 2.52-18.04], CV 4.57 [95% CI, 1.77-11.81], and max-min 4.34 [95% CI, 1.72-10.93]).
In patients with acute ICH, BPV was a strong predictor of the 3-month clinical outcome and may represent a still neglected potential therapeutic target.
本研究旨在评估自发性脑出血（ICH）急性期出现的血压（BP）水平波动是否会影响3个月时的临床结局。
我们回顾性纳入了因急性自发性ICH住院的连续患者。记录症状发作后最初72小时内的血压测量值，并确定标准差（SD）、变异系数（CV）和最大-最小差值（max-min），以表征收缩压和舒张压变异性（BPV）。结局指标是在进行基线严重程度调整分析后，采用改良Rankin量表评估的3个月功能状态。
在138例纳入研究的ICH患者中，67例（48.6%）被归类为3个月功能恢复较差。对于收缩压BPV的各项指标，均发现与不良结局存在剂量反应关系——SD最高三分位数的调整优势比（OR）为7.95（95%置信区间[CI]，2.88-21.90），CV为7.74（95%CI，2.88-20.80），max-min为8.36（95%CI，2.72-25.62；P<.001）。与舒张压BPV的关联强度较弱，仅在较高值时具有显著性（SD最高三分位数的调整OR为6.74[95%CI，2.52-18.04]，CV为4.57[95%CI，1.77-11.81]，max-min为4.34[95%CI，1.72-10.93]）。
在急性ICH患者中，BPV是3个月临床结局的强有力预测指标，可能代表一个仍被忽视的潜在治疗靶点。
