CAJ | 학술논문

目的分析卒中急性期患者血压变异性的特征，并探讨卒中不同类型间血压变异性的相关性。 　　方法本研究为前瞻性研究，连续选取首都医科大学附属北京天坛医院神经内科2012年3月至2012年12月住院的、确诊为急性卒中患者306例。根据卒中类型分为脑出血组及缺血性卒中组，其中缺血性卒中组根据中国缺血性卒中分型（China Ischemic Stroke Subclassification，CISS）分为大动脉粥样硬化亚组及非大动脉粥样硬化亚组，所有患者均完成24 h动态血压监测，收集患者24 h、白天及夜间收缩压（systolic blood pressure，SBP）、舒张压（diastolic blood pressure，DBP）、平均血压（mean blood pressure，MBP）、脉压（pulse pressure，PP）、心率（heart rate，HR）、发病后21天或出院时的改良Rankin量表（modified Rankin Scale，mRS）评分，比较各组患者的一般资料、既往病史、美国国立卫生研究院卒中量表（National Institute of Health Stroke Scale，NIHSS）、mRS评分、MBP及血压变异性指标，包括SBP、DBP、MBP、PP的标准差（standard deviation，SD）、变异系数（coefficient of variation，CV：等于SD/平均值×100%）等。 　　结果血压平均值显示卒中急性期血压以点增高为主，24 h MBP指标无显著增高；脑出血组的24 h DBP、白日DBP、夜间DBP以及24 h HR、白日HR、夜间HR均高于缺血性卒中组，差异具有显著性（P<0.05）。缺血性卒中组24 h PP、白日PP、夜间PP均显著高于脑出血组，差异有显著性（P<0.05）。血压变异性显示脑出血组与缺血性卒中组间血压变异性差异有显著性（SBP及MBP的标准差，SBP、DBP及MBP的血压变异性各项比较P<0.05），提示缺血性卒中的血压变异性更大；而大动脉粥样硬化性卒中与非大动脉粥样硬化性卒中比较血压变异性差异无显著性。 　　结论卒中不同类型间血压变异性存在显著差异，其中缺血性卒中患者血压变异性更大。目的分析卒中急性期患者血壓變異性的特徵，併探討卒中不同類型間血壓變異性的相關性。 　　方法本研究為前瞻性研究，連續選取首都醫科大學附屬北京天罈醫院神經內科2012年3月至2012年12月住院的、確診為急性卒中患者306例。根據卒中類型分為腦齣血組及缺血性卒中組，其中缺血性卒中組根據中國缺血性卒中分型（China Ischemic Stroke Subclassification，CISS）分為大動脈粥樣硬化亞組及非大動脈粥樣硬化亞組，所有患者均完成24 h動態血壓鑑測，收集患者24 h、白天及夜間收縮壓（systolic blood pressure，SBP）、舒張壓（diastolic blood pressure，DBP）、平均血壓（mean blood pressure，MBP）、脈壓（pulse pressure，PP）、心率（heart rate，HR）、髮病後21天或齣院時的改良Rankin量錶（modified Rankin Scale，mRS）評分，比較各組患者的一般資料、既往病史、美國國立衛生研究院卒中量錶（National Institute of Health Stroke Scale，NIHSS）、mRS評分、MBP及血壓變異性指標，包括SBP、DBP、MBP、PP的標準差（standard deviation，SD）、變異繫數（coefficient of variation，CV：等于SD/平均值×100%）等。 　　結果血壓平均值顯示卒中急性期血壓以點增高為主，24 h MBP指標無顯著增高；腦齣血組的24 h DBP、白日DBP、夜間DBP以及24 h HR、白日HR、夜間HR均高于缺血性卒中組，差異具有顯著性（P<0.05）。缺血性卒中組24 h PP、白日PP、夜間PP均顯著高于腦齣血組，差異有顯著性（P<0.05）。血壓變異性顯示腦齣血組與缺血性卒中組間血壓變異性差異有顯著性（SBP及MBP的標準差，SBP、DBP及MBP的血壓變異性各項比較P<0.05），提示缺血性卒中的血壓變異性更大；而大動脈粥樣硬化性卒中與非大動脈粥樣硬化性卒中比較血壓變異性差異無顯著性。 　　結論卒中不同類型間血壓變異性存在顯著差異，其中缺血性卒中患者血壓變異性更大。
목적분석졸중급성기환자혈압변이성적특정，병탐토졸중불동류형간혈압변이성적상관성。 　　방법본연구위전첨성연구，련속선취수도의과대학부속북경천단의원신경내과2012년3월지2012년12월주원적、학진위급성졸중환자306례。근거졸중류형분위뇌출혈조급결혈성졸중조，기중결혈성졸중조근거중국결혈성졸중분형（China Ischemic Stroke Subclassification，CISS）분위대동맥죽양경화아조급비대동맥죽양경화아조，소유환자균완성24 h동태혈압감측，수집환자24 h、백천급야간수축압（systolic blood pressure，SBP）、서장압（diastolic blood pressure，DBP）、평균혈압（mean blood pressure，MBP）、맥압（pulse pressure，PP）、심솔（heart rate，HR）、발병후21천혹출원시적개량Rankin량표（modified Rankin Scale，mRS）평분，비교각조환자적일반자료、기왕병사、미국국립위생연구원졸중량표（National Institute of Health Stroke Scale，NIHSS）、mRS평분、MBP급혈압변이성지표，포괄SBP、DBP、MBP、PP적표준차（standard deviation，SD）、변이계수（coefficient of variation，CV：등우SD/평균치×100%）등。 　　결과혈압평균치현시졸중급성기혈압이점증고위주，24 h MBP지표무현저증고；뇌출혈조적24 h DBP、백일DBP、야간DBP이급24 h HR、백일HR、야간HR균고우결혈성졸중조，차이구유현저성（P<0.05）。결혈성졸중조24 h PP、백일PP、야간PP균현저고우뇌출혈조，차이유현저성（P<0.05）。혈압변이성현시뇌출혈조여결혈성졸중조간혈압변이성차이유현저성（SBP급MBP적표준차，SBP、DBP급MBP적혈압변이성각항비교P<0.05），제시결혈성졸중적혈압변이성경대；이대동맥죽양경화성졸중여비대동맥죽양경화성졸중비교혈압변이성차이무현저성。 　　결론졸중불동류형간혈압변이성존재현저차이，기중결혈성졸중환자혈압변이성경대。
Objective To analyze the characteristics of blood pressure variability(BPV) in acute stroke patients, and to explore the association between BPV and different types of stroke. Methods A prospective study was conducted among 306 consecutively admitted patients of acute stroke from the department of Neurology in Beijing Tiantan Hospital during the period from March 2012 to December 2012. Patients were divided into cerebral hemorrhage group and ischemic stroke (IS) group. The latter was further divided into large artery atherosclerosis(LAA) subgroup and non-LAA subgroup according to China Ischemic Stroke Subclassification(CISS). Twenty four hour ambulatory blood pressure monitoring(ABPM) was tested in all the patients, and the index were recorded, including systolic blood pressure(SBP) (24-hour, day-time and night-time), diastolic blood pressure(DBP) (24-hour, day-time and night-time), mean blood pressure(MBP) (24-hour, day-time and night-time), pulse pressure(PP) (24-hour, day-time and night-time), heart rate(HR) (24-hour,day-time and night-time), and modiifed Rankin Scale(mRS) score. mRS score was recorded when patients discharged or on the 21st day after their onset. One-way analysis of variance, chi-quare test and logistic regression were applied to evaluate the differences of the indicators between different groups, which included general information, past medical history, neurological function, mRS score, MBP, and indicators of BPV(the standard deviation[SD] and the coefficient of variation[CV] of SBP, DBP, MBP and PP). Results A total of 306 cases of acute stroke patients were investigated, including 123 cerebral hemorrhage cases and 183 cerebral infarction(CI) cases. (1) There was no signiifcant increase in the value of 24 h-MBP in acute stroke patients. The values of 24 h-DBP, d-DBP(day-time DBP), n-DBP(night-time DBP) , 24 h-HR, d-HR, n-HR in cerebral hemorrhage group were signiifcantly higher than those in CI group. Conversely, the value of 24 h-PP, d-PP, n-PP in CI group were signiifcantly higher than those incerebral hemorrhage group. (2) BPV was signiifcantly different in cerebral hemorrhage group and ischemic stroke group. P value of the SD of SBP and MBP, the CV of SBP, DBP and MBP were all below 0.05, which indicated that cerebral infarction patients hadhigher BPV. However, there were no signiifcant differences of BPV between the two subgroups, LAA group and non-LAA group. (3) Acute stroke patients hada higher proportion of non-dipper blood pressure, but there were no statistically significant differences between different types of stroke, as well as in different subgroups. Conclusion (1) In this study, we found that the average DBP and the average HR in cerebral hemorrhage group were higher than those in CI group. Average PP in CI group was higher than that in cerebral hemorrhage group. There was no signiifcant difference of MBP between the two subgroups of CI. (2) BPV was signiifcantly different between the cerebral hemorrhage group and the CI group. The latter had greater BPV. However, there was no signiifcant differences of BPV between the subtypes of cerebral infarction. (3) Patients with acute stroke has a higher proportion of non-dipper blood pressure, but when it came to different types of strokeand different subtypes of CI, the differences were not signiifcant.