缺血性脑卒中早期血压及脑卒中亚型对卒中后认知障碍的影响。
Effects of Blood Pressure in the Early Phase of Ischemic Stroke and Stroke Subtype on Poststroke Cognitive Impairment.
机构信息
From the First People's Hospital of Lianyungang City, Jiangsu, China (M.H., N.L., S.G., P.M., N.J., Y.S., B.X., Y.X., X.Z., G.Z., X.H., Z.C., Z.L., B.W., B.X.).
College of Medical Science, China Three Gorges University, Yichang (J.W.).
出版信息
Stroke. 2018 Jul;49(7):1610-1617. doi: 10.1161/STROKEAHA.118.020827. Epub 2018 Jun 12.
BACKGROUND AND PURPOSE
Blood pressure (BP) control in the early phase of stroke is controversial to reduce the risk of poststroke cognitive impairment (PSCI). This study was to investigate the impact of BP levels in the early phase of ischemic stroke and stroke subtype on PSCI.
METHODS
Seven hundred and ninety-six patients with acute ischemic stroke were included. Cognitive function was assessed after stroke onset using the Montreal Cognitive Assessment. Patients were divided into quintiles according to systolic BP and diastolic BP levels in the early phase. Subtype analyses were according to Trial of ORG 10172 in Acute Stroke Treatment classification (infarct cause) and Oxfordshire Community Stroke Project classification (infarct location).
RESULTS
After adjusting for multiple variables, the quintiles with the lowest systolic BP (Q1, 102-127 mm Hg) and with the highest systolic BP (Q5, 171-215 mm Hg) were associated with increased PSCI risk (odds ratio, 1.83; 95% confidence interval, 1.64-2.28; =0.007 in Q1; odds ratio, 2.32; 95% confidence interval, 1.74-2.90; <0.001 in Q5) at 3 months as compared with the middle quintile (Q3, 143-158 mm Hg). Similar association was found in diastolic BP quintiles. The analysis of cerebral infarction subtype demonstrated that both large artery atherosclerosis and total anterior circulation infarct were associated with increased risk of PSCI at 3 months after adjusting for multiple variables (large artery atherosclerosis: odds ratio, 1.42; 95% confidence interval, 1.06-1.90; =0.031; total anterior circulation infarct: odds ratio, 1.68; 95% confidence interval, 1.32-2.15; =0.001).
CONCLUSIONS
Lower or higher BP in the early phase of ischemic stroke was correlated with increased PSCI risk at 3 months. Maintaining systolic/diastolic BP in the levels of 143 to 158/93 to 102 mm Hg might be beneficial to reduce the occurrence of PSCI. Moreover, large artery atherosclerosis subtype and total anterior circulation infarct subtype were correlated with increased PSCI risk at 3 months.
CLINICAL TRIAL REGISTRATION
URL: https://www.chictr.org. Unique identifier: ChiCTR-TRC-14004804.
背景与目的
降低卒中后认知障碍（PSCI）风险的降压治疗在卒中早期阶段仍存在争议。本研究旨在探讨缺血性卒中早期血压水平和卒中亚型对 PSCI 的影响。
方法
共纳入 796 例急性缺血性卒中患者。采用蒙特利尔认知评估量表评估卒中后认知功能。根据收缩压和舒张压的五分位值将患者分为五组。根据组织型纤溶酶原激活剂治疗急性卒中试验分类（梗死原因）和牛津郡社区卒中项目分类（梗死部位）进行亚型分析。
结果
在校正多个变量后，收缩压最低的五分位组（Q1，102-127mmHg）和收缩压最高的五分位组（Q5，171-215mmHg）与 3 个月时 PSCI 风险增加相关（比值比，1.83；95%置信区间，1.64-2.28；Q1 组 =0.007；比值比，2.32；95%置信区间，1.74-2.90；Q5 组 <0.001）。舒张压五分位组也存在类似的相关性。在脑梗死亚型分析中，在校正多个变量后，大动脉粥样硬化和全前循环梗死均与 3 个月时 PSCI 风险增加相关（大动脉粥样硬化：比值比，1.42；95%置信区间，1.06-1.90；=0.031；全前循环梗死：比值比，1.68；95%置信区间，1.32-2.15；=0.001）。
结论
缺血性卒中早期的较低或较高血压与 3 个月时 PSCI 风险增加相关。维持收缩压/舒张压在 143-158/93-102mmHg 水平可能有助于降低 PSCI 的发生。此外，大动脉粥样硬化亚型和全前循环梗死亚型与 3 个月时 PSCI 风险增加相关。
临床试验注册
网址：https://www.chictr.org. 唯一标识符：ChiCTR-TRC-14004804。
Zotero 插件