CAJ | 학술논문

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.入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Loistic多因素分析得:当高同型半胱氨酸血症界值为15 μmol/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 =2.566 95％ 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、入院舒张压.结论当高同型半胱氨酸血症界值为15 μmol/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.
목적 연구H형고혈압즉반유고동형반광안산혈증적고혈압여결혈성뇌졸중예후적관계.방법 련속납입2007년1월1일지2010년5월30일입주정주대학제일부속의원신경내과적결혈성뇌졸중환자,전부경두로CT혹MRI명학진단.입원당천사용미국국립위생원졸중량표(NIHSS)대환자진행신경공능결손평분,병기록환자기선자료화결혈성뇌졸중예후가능상관적인소.재환자발병후6개월대환자진행수방,병기록개량적Rankin( MRS)량표평분.통계분석사용Logistic회귀분석.결과 공납입환자634례,6개월수방실방32례(5％),녀197례(32.7％),남405례(67.3％),년령:(19 ～92)세,평균년령위(59±13)세；입원후동형반광안산평균수평위(19±11) μmol/L;환자중고혈압병343례(57％)；MRS≥3분자145례(31％).경Loistic다인소분석득:당고동형반광안산혈증계치위15 μmol/L,H형고혈압여결혈성뇌졸중6개월신경공능예후유관(P=0.012,OR =2.566 95％ CI:1.299 ～5.357),고혈압급고동형반광안산혈증지간존재정상가적교호작용[초액상대위험도(RERI)、교호작용귀인비(AP)화교호작용지수(S)분별위:0.683、26.61％、1.59],기타영향결혈성졸중예후적인소유:년령、졸중사、입원NIHSS、입원서장압.결론 당고동형반광안산혈증계치위15 μmol/L,H형고혈압여결혈성뇌졸중6개월신경공능예후상관,시결혈성뇌졸중예후적위험인소；고혈압여고동형반광안산공존시대결혈성뇌졸중6개월신경공능예후표현위정상가교호작용.
Objective To examine the correlation between hypertension with hyperhomocysteinemia and prognosis of ischemic stroke.Methods A total of 634 patients with acute ischemic stroke confirmed by computed tomography 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 homocysteine 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 homocysteine ≥ 15 μ mol/L was defined for hyperhomocysteinemia. And there was a total sum of interaction between hypertension and hyperhomocysteinemia.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 hyperhomocysteinemia coexist,there is a total sum of interaction.