Qi Xuemei, Wang Zhongyan, Xia Xiaoshuang, Xue Juanjuan, Gu Yumeng, Han Suqin, Yao Qing, Cai Ziying, Wang Xiaojia, Wang Lin, Leng Sean X, Li Xin
Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China.
Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China.
Ann Transl Med. 2021 Feb;9(4):309. doi: 10.21037/atm-20-4256.
This study aimed to explore the effects of heatwaves and cold spells on blood pressure, thrombus formation, and systemic inflammation at admission in patients with ischemic stroke.
Data of patients with ischemic stroke who were admitted to the Second Hospital of Tianjin Medical University between May 2014 and March 2019 were reviewed, along with meteorological data from the same time period. A total of 806 clinically confirmed patients with ischemic stroke (34-97 years old) were included in the final analysis. Heatwaves and cold spells were defined as ≥2 consecutive days with average temperature >95 percentile (May-August) and <5 percentile (November-March), respectively. Coagulation parameters, inflammation indices, blood pressure, and neurological impairment were evaluated within 24 hours of admission. General linear and logistic regression models were created to investigate the relationships of heatwaves and cold spells with the examination results of patients with ischemic stroke at admission.
After adjustment for potential environmental confounders, heatwaves were positively associated with high systolic blood pressure (SBP) (β=8.693, P=0.019), diastolic blood pressure (DBP) (β=3.665, P=0.040), reduced thrombin time (TT) (β=-0.642, P=0.027), and activated partial thromboplastin time (APTT) (β=-1.572, P=0.027) in ischemic stroke patients at admission. Cold spells were positively associated with high SBP (β=5.277, P=0.028), DBP (β=4.672, P=0.012), fibrinogen (β=0.315, P=0.011), globulin (β=1.523, P=0.011), and reduced TT (β=-0.784, P<0.001) and APTT (β=-1.062, P=0.024). Cold spells were also associated with a higher risk of respiratory infection [odds ratio (OR) =2.677, P=0.001].
Exposure to heatwaves or cold spells was associated with blood pressure and coagulation at admission in patients with ischemic stroke. Cold spells also resulted in higher levels of inflammation. These findings suggest that changes in coagulation, blood pressure, and inflammation may be the potential biological mechanisms underlying the cerebrovascular effects of exposure to extreme temperatures.
本研究旨在探讨热浪和寒潮对缺血性脑卒中患者入院时血压、血栓形成及全身炎症的影响。
回顾了2014年5月至2019年3月期间天津医科大学第二医院收治的缺血性脑卒中患者的数据，以及同一时期的气象数据。最终分析纳入了806例临床确诊的缺血性脑卒中患者（年龄34 - 97岁）。热浪和寒潮分别定义为连续≥2天平均气温>第95百分位数（5 - 8月）和<第5百分位数（11月至次年3月）。在入院24小时内评估凝血参数、炎症指标、血压和神经功能缺损情况。建立一般线性和逻辑回归模型，以研究热浪和寒潮与缺血性脑卒中患者入院检查结果之间的关系。
在对潜在环境混杂因素进行校正后，热浪与缺血性脑卒中患者入院时的高收缩压（SBP）（β = 8.693，P = 0.019）、舒张压（DBP）（β = 3.665，P = 0.040）、凝血酶时间（TT）缩短（β = - 0.642，P = 0.027）以及活化部分凝血活酶时间（APTT）缩短（β = - 1.572，P = 0.027）呈正相关。寒潮与高SBP（β = 5.277，P = 0.028）、DBP（β = 4.672，P = 0.012）、纤维蛋白原（β = 0.315，P = 0.011）、球蛋白（β = 1.523，P = 0.011）以及TT缩短（β = - 0.784，P < 0.001）和APTT缩短（β = - 1.062，P = 0.024）呈正相关。寒潮还与呼吸道感染风险较高相关[比值比（OR）= 2.677，P = 0.001]。
暴露于热浪或寒潮与缺血性脑卒中患者入院时的血压和凝血情况相关。寒潮还导致炎症水平升高。这些发现表明，凝血、血压和炎症的变化可能是暴露于极端温度下脑血管效应的潜在生物学机制。
