摘要
目的研究H型高血压即伴有高同型半胱氨酸血症的高血压与缺血性脑卒中预后的关系。方法连续纳入2007年1月1日至2010年5月30日入住郑州大学第一附属医院神经内科的缺血性脑卒中患者，全部经头颅CT或MRI明确诊断。人院当天使用美国国立卫生院卒中量表（NIHSS）对患者进行神经功能缺损评分，并记录患者基线资料和缺血性脑卒中预后可能相关的因素。在患者发病后6个月对患者进行随访，并记录改良的Rankin（MRS）量表评分。统计分析使用Logistic回归分析。结果共纳入患者634例，6个月随访失访32例（5％），女197例（32．7％），男405例（67．3％），年龄：（19-92）岁，平均年龄为（59±13）岁；入院后同型半胱氨酸平均水平为（19±11）μmol／L；患者中高血压病343例（57％）；MRS≥3分者145例（31％）。经Logistic多因素分析得：当高同型半胱氨酸血症界值为15μmol／L，H型高血压与缺血性脑卒中6个月神经功能预后有关（P=0．012，OR=2．56695％CI：1．299-5．357），高血压及高同型半胱氨酸血症之间存在正相加的交互作用[超额相对危险度（RERI）、交互作用归因比（AP）和交互作用指数（S）分别为：0．683、26．61％、1．59]，其他影响缺血性卒中预后的因素有：年龄、卒中史、入院NIHSS、人院舒张压。结论当高同型半胱氨酸血症界值为15μmol／L，H型高血压与缺血性脑卒中6个月神经功能预后相关，是缺血性脑卒中预后的危险因素；高血压与高同型半胱氨酸共存时对缺血性脑卒中6个月神经功能预后表现为正相加交互作用。
Objective To examine the correlation between hypertension with hyperhomocysteinemia and prognosis of ischemic stroke. Methods A total of 634 patients with acute iscbemic stroke confirmed by computed tomograpby or magnetic resonance imaging were recruited at Department of Neurology, First Affiliated Hospital, Zhengzhou University from January 1, 2007 to May 30, 2010. Their NIHSS （ National Institute of Health Stroke Scale ） scores were evaluated on admission. And their baseline profiles and probable prognostic factors were recorded. Recovery was assessed by modified Rankin score （MRS） during a 6-month follow-up. Multivariate Logistic regression was performed for statistical analysis. Results Among them, 32 became lost to follow-up. There were 197 females（32.7% ）and 405 males （67.3%） with an average age of （59 ± 13） years （range： 19 -92）. The average level of bomocysteine was（ 19 ± 11 ） μmol/ L. There were 343 （57%） patients with hypertension and MRS≥3 was in 145 （31%） patients. Logistic regression analysis showed that significant correlations existed between H-type hypertension and 6-month MRS （P =0.012, OR = 2. 566, 95% CI： 1. 299 - 5. 357） when bomoeysteine≥ 15μmol/L was defined for hyperbomoeysteinemia. And there was a total sum of interaction between hypertension and byperbomocysteinemia. The parameters of relative excess risk of interaction （RERI）, attributable proportion due to interaction （AP） and synergy index （S）were 0. 683, 26. 61% and 1. 59 respectively. Other parameters with significant prognostic correlations included age, history of stroke, NIHSS score on admission and diastolic blood pressure on admission. Conclusion At the homocysteine level of ≥ 15 μmol/L, H-type hypertension and 6-month MRS have significant correlations. And H-type hypertension is a risk factor for the prognosis of ischemic stroke. When hypertension and hyperbomoeysteinemia coexist, there is a total sum of interaction.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2012年第17期1183-1186,共4页
National Medical Journal of China
关键词
脑缺血
卒中
交互作用
预后
Brain ischemic stroke
Stroke
Interaction
Prognosis
