CAJ | 학술논문

目的：高血压与缺血性卒中复发之间的关系尚未有定论，但其对缺血性卒中各亚型复发的影响可能存在差异。本文旨在探讨高血压与缺血性卒中各亚型复发风险的关系。方法采用前瞻性队列研究的方法，选取2008年7月至2012年12月在南京卒中注册系统注册的患者，最终纳入缺血性卒中患者1114例。按照急性卒中Orgl 10172治疗试验（ Trial of Org 10172 in Acute Stroke Treatment， TOAST）分型对其进行分型，其中大动脉粥样硬化型（large-artery atheroselerosis， LAA）315例（28．3％）、心源性栓塞型（cardioembolism， CE）212例（19．0％）、小动脉闭塞型（small-artery occlusion， SAO）266例（23．9％）、不明原因及其他病因型（other determined and undetermined etiologies ， Other）321例（28．8％）。利用多因素Cox回归分析高血压对缺血性卒中各亚型复发风险的影响。结果入组患者平均随访（19．4±10．3）个月，158例（14．2％）患者在随访期内出现卒中复发。高血压患者卒中复发率高于非高血压患者（16．5％vs 10．5％，P＜0．05）。多因素Cox回归分析结果显示，高血压是缺血性卒中复发的独立危险因素（HR＝1．722，95％CI：1．181～2．512，P＝0．005）。 TOAST分型中，高血压可增加LAA亚型（HR＝3．767，95％CI：1．866～7．585，P＝0．001）和SAO亚型（HR＝3．838，95％CI：1．156～12．740，P＝0．028）卒中的复发风险，对CE亚型和Other亚型复发影响不显著（CE亚型：HR＝0．773，95％CI：0．370～1．615，P＝0．493；Other亚型：HR＝1．498，95％CI：0．590～3．807，P＝0．395）。结论高血压是缺血性卒中复发的独立危险因素，有增加LAA亚型和SAO亚型卒中复发的风险。
목적：고혈압여결혈성졸중복발지간적관계상미유정론，단기대결혈성졸중각아형복발적영향가능존재차이。본문지재탐토고혈압여결혈성졸중각아형복발풍험적관계。방법채용전첨성대렬연구적방법，선취2008년7월지2012년12월재남경졸중주책계통주책적환자，최종납입결혈성졸중환자1114례。안조급성졸중Orgl 10172치료시험（ Trial of Org 10172 in Acute Stroke Treatment， TOAST）분형대기진행분형，기중대동맥죽양경화형（large-artery atheroselerosis， LAA）315례（28．3％）、심원성전새형（cardioembolism， CE）212례（19．0％）、소동맥폐새형（small-artery occlusion， SAO）266례（23．9％）、불명원인급기타병인형（other determined and undetermined etiologies ， Other）321례（28．8％）。이용다인소Cox회귀분석고혈압대결혈성졸중각아형복발풍험적영향。결과입조환자평균수방（19．4±10．3）개월，158례（14．2％）환자재수방기내출현졸중복발。고혈압환자졸중복발솔고우비고혈압환자（16．5％vs 10．5％，P＜0．05）。다인소Cox회귀분석결과현시，고혈압시결혈성졸중복발적독립위험인소（HR＝1．722，95％CI：1．181～2．512，P＝0．005）。 TOAST분형중，고혈압가증가LAA아형（HR＝3．767，95％CI：1．866～7．585，P＝0．001）화SAO아형（HR＝3．838，95％CI：1．156～12．740，P＝0．028）졸중적복발풍험，대CE아형화Other아형복발영향불현저（CE아형：HR＝0．773，95％CI：0．370～1．615，P＝0．493；Other아형：HR＝1．498，95％CI：0．590～3．807，P＝0．395）。결론고혈압시결혈성졸중복발적독립위험인소，유증가LAA아형화SAO아형졸중복발적풍험。
Objective The relationship between hypertension ( HTN) and ischemic stroke recurrence is unclear , but there may be different effects of HTN on the risk of recurrence .This study aims to explore whether HTN contributes differently to the recur-rence among subtypes of ischemic stroke ( IS) . Methods We eventually enrolled 1114 patients with ischemic stroke from Jul 2008 to Dec 2012 registered in Nanjing Stroke Registry Program (NSRP) in this study.All the patients were classified according to Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria: 315 (28.3%) patiwnts were classified as Large-artery atheroselerosis (LAA), 212 (19.0%) as cardioembolism (CE), 266 (23.9%) as small-artery occlusion (SAO), and 321 (28.8%) as other de-termined and undetermined etiologies ( Other) .The association between HTN and stroke recurrence in patients with different IS sub-types was analyzed using multivariate Cox regression analysis . Results The average follow-up duration was (19.4 ±10.3) months. Of 1114 patients with IS, 158 (14.2%) patients experienced a recurrent stroke .Patients with HTN had a significantly higher stroke recurrence rate than those without (16.5%vs 10.5%, P<0.05).Multivariate Cox regression analysis indicated that HTN increased the risk of ischemic stroke recurrence (HR=1.722, 95%CI:1.181-2.512, P=0.005).After stratification by TOAST subtypes, analysis revealed an association between HTN and stroke recurrence in LAA( HR=3 .767, 95%CI:1.866-7.585, P=0.001) and SAO (HR=3.530, 95%CI:1.156-12.740, P=0.028), but not in the other subtypes (CE: HR=0.773, 95%CI:0.370-1.615, P=0.493;Other:HR=1.498, 95%CI:0.590-3.807, P=0.395). Conclusion HTN is an independent risk factor for recurrent ischemic stroke and is related to the recurrent ischemic stroke in patients with large-artery and small-vessel disease .