Wu Qinhua, Qu Jianfeng, Yin Yong, Wang Aihong, Cheng Wei, Duan Ruikang, Zhang Bin
Department of Neurology, Fengxian Branch, Shanghai Jiaotong University Affiliated 6th People's Hospital, Shanghai, China.
Medicine (Baltimore). 2018 Aug;97(34):e12013. doi: 10.1097/MD.0000000000012013.
This study aimed to investigate risk factors (such as morning hypertension, drug compliance, and biochemical parameters) of macrovascular events after cerebral infarction.This was a retrospective study of patients with cerebral infarction admitted between May 2015 and April 2016 at the Fengxian Branch, 6th People's Hospital of Shanghai. They were divided into the macrovascular events and control groups according to the diagnosis of macrovascular events following cerebral infarction.Among the 702 patients included for analysis, 122 patients were with macrovascular events and 580 were without macrovascular events (controls). Morning hypertension (P = .01), dyslipidemia (P = .007), atrial fibrillation (P = .039), carotid artery plaque (P = .014), inflammatory infection (P = .005), high homocysteine (P = .032), antithrombotic compliance (P < .001), statins compliance (P < .001), morning diastolic blood pressure (P < .001), morning systolic blood pressure (P < .001), and morning heart rate (morHR) (P = .033) were associated with macrovascular events. Multivariable analysis showed that morning hypertension (P = .021, odds ratio [OR] = 1.753, 95% confidence interval [CI] [1.088, 2.826]), dyslipidemia (P = .021, OR = 1.708, 95% CI [1.085, 2.687]), and inflammatory infection (P = .031, OR = 2.263, 95% CI [1.078, 4.752]) were independent risk factors for macrovascular events, while antithrombotic compliance (P < .001, OR = 0.488, 95% CI [0.336, 0.709]), statin compliance (P = .02, OR = 0.64, 95% CI [0.44, 0.931]), and morHR (P = .027, OR = 0.977, 95% CI [0.958, 0.997]) were independent protective factors against macrovascular events. Atrial fibrillation showed a tendency to be associated with macrovascular events (P = .077, OR = 1.531, 95% CI [0.955, 2.454]).Morning hypertension, dyslipidemia, and inflammatory infection may increase the risk of macrovascular events following cerebral infarction. Improving morning blood pressure management and drug compliance (antithrombotic drugs and statins) may reduce the risk of macrovascular events following cerebral infarction.
本研究旨在调查脑梗死患者发生大血管事件的危险因素（如清晨高血压、药物依从性及生化指标）。本研究为回顾性研究，纳入了2015年5月至2016年4月在上海市第六人民医院奉贤分院住院的脑梗死患者。根据脑梗死患者发生大血管事件的诊断情况将其分为大血管事件组和对照组。纳入分析的702例患者中，122例发生大血管事件，580例未发生大血管事件（对照组）。清晨高血压（P = 0.01）、血脂异常（P = 0.007）、心房颤动（P = 0.039）、颈动脉斑块（P = 0.014）、炎症感染（P = 0.005）、高同型半胱氨酸血症（P = 0.032）、抗栓治疗依从性（P < 0.001）、他汀类药物依从性（P < 0.001）、清晨舒张压（P < 0.001）、清晨收缩压（P < 0.001）及清晨心率（morHR）（P = 0.033）与大血管事件相关。多因素分析显示，清晨高血压（P = 0.021，比值比[OR]=1.753，95%置信区间[CI][1.088, 2.826]）、血脂异常（P = 0.021，OR = 1.708，95% CI [1.085, 2.687]）及炎症感染（P = 0.031，OR = 2.263，95% CI [1.078, 4.752]）是大血管事件的独立危险因素，而抗栓治疗依从性（P < 0.001，OR = 0.488，95% CI [0.336, 0.709]）、他汀类药物依从性（P = 0.02，OR = 0.64，95% CI [0.44, 0.931]）及morHR（P = 0.027，OR = 0.977，95% CI [0.958, 0.997]）是大血管事件的独立保护因素。心房颤动与大血管事件存在关联趋势（P = 0.077，OR = 1.531，95% CI [0.955, 2.454]）。清晨高血压、血脂异常及炎症感染可能增加脑梗死患者发生大血管事件的风险。改善清晨血压管理及药物依从性（抗栓药物和他汀类药物）可能降低脑梗死患者发生大血管事件的风险。
