H型高血压与LAA型急性脑梗死早期神经功能缺损严重程度的关系

doi:10.3969/j.issn.1004-583X.2021.07.007

摘要/Abstract

摘要：

目的探讨H型高血压与大动脉粥样硬化(LAA)型急性脑梗死早期神经功能缺损严重程度的关系。方法 LAA型急性脑梗死患者270例,详细记录患者一般资料,24小时内检测患者空腹血清同型半胱氨酸(Hcy)水平,根据患者有无高血压及血清Hcy水平将患者分为H型高血压组(患有高血压伴Hcy≥10 μmol/L),单纯高血压组(仅患有高血压),单纯高Hcy组(仅Hcy≥10 μmol/L),对照组(既无高血压又无Hcy升高);按照美国国立卫生院卒中量表(NIHSS)评定患者入院时神经功能缺损严重程度(轻度NIHSS≤5分,中重度NIHSS>5分)。分析H型高血压与LAA型急性脑梗死早期神经功能缺损严重程度的相关性。结果中重度急性脑梗死患者H型高血压发生率高于轻度急性脑梗死患者(P<0.01);高血压与高Hcy对神经功能缺损严重程度交互作用指数(S)>1,有正交互作用。结论 H型高血压可能是LAA型急性脑梗死早期神经功能恶化的危险因素,并且高血压、高Hcy对神经功能恶化存在协同作用。

关键词: 高血压, 高半胱氨酸, 脑梗死, 神经病学表现

Abstract:

Objective To explore the relationship between H-type hypertension and the severity of neurological deficits in the early acute cerebral infarction of large atherosclerosis (LAA).Methods The general information of 270 patients with acute cerebral infarction of LAA were recorded, the fasting serum homocysteine (Hcy) within 24 hours were performed in all patients. According to with or without of hypertension and serum Hcy levels, the patients were divided into H-type hypertension group (hypertension and Hcy≥10 μmol/L), simple hypertension group (only hypertension), and simple high Hcy group (only Hcy≥10 μmol/L), control group (without hypertension and elevated Hcy). National Institutes of Health Stroke Scale (NIHSS) was used to assess the severity degree of neurological deficits at admission (mild NIHSS ≤5 points, moderate to severe NIHSS> 5 points). The analysis was made for the correlation between H-type hypertension and the severity of neurological deficits in the early acute cerebral infarction of LAA.Results The incidence of H-type hypertension in patients with moderate to severe acute cerebral infarction was higher than that in patients with mild acute cerebral infarction (P<0.01); the interaction index (S)>1 of hypertension and high Hcy on the severity of neurological deficits had a positive interaction.Conclusion H-type hypertension may be a risk factor for the deterioration of neurological function in the early acute cerebral infarction of LAA, and hypertension and high Hcy have a synergistic effect on the deterioration of neurological function.

Key words: hypertension, homocysteine, brain infarction, neurologic manifestations

中图分类号:

巩涛, 胡月圆, 高云, 郭畅, 沈慧楠, 王东玉. H型高血压与LAA型急性脑梗死早期神经功能缺损严重程度的关系[J]. 临床荟萃, 2021, 36(7): 612-615.

Gong Tao, Hu Yueyuan, Gao Yun, Guo Chang, Shen Huinan, Wang Dongyu. Relationship between H-type hypertension and severity of neurological deficit in early acute cerebral infarction of LAA[J]. Clinical Focus, 2021, 36(7): 612-615.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.07.007

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I7/612

图/表 5

表1 两组一般资料比较

项目	轻度 (n=147)	中重度 (n=123)	统计值	P值
年龄[ $x -$ ±s,岁]	65.33±10.03	68.71±11.17	t=-2.60	0.01
性别[男,例(%)]	86(58.50)	87(70.70)	Z=4.35	0.04
吸烟[例(%)]	50(34.00)	49(39.80)	Z=0.99	0.32
高血压[例(%)]	94(63.90)	83(67.50)	Z=0.37	0.54
糖尿病[例(%)]	54(36.70)	46(37.40)	Z=0.01	0.91
H型高血压[例(%)]	52(35.37)	76(61.79)	Z=18.74	0.00
Hcy[M(QR),μmol/L]	11.45(3.99)	17.38(10.38)	Z=-9.32	0.00
收缩压( $x -$ ±s,mmHg)	150.63±19.14	153.78±21.81	t=-1.25	0.21
舒张压( $x -$ ±s,mmHg)	87.24±11.15	87.26±11.03	t=-0.02	0.99
葡萄糖[M(QR),mmol/L]	6.18(2.73)	6.39(2.85)	Z=-0.29	0.77
甘油三酯( $x -$ ±s,mmol/L)	1.81±0.78	1.76±0.83	t=0.52	0.60
胆固醇( $x -$ ±s,mmol/L)	4.33±0.91	4.36±0.76	t=-0.32	0.75
低密度脂蛋白胆固醇 ( $x -$ ±s,mmol/L)	3.01±0.79	3.00±0.73	t=0.07	0.95
高密度脂蛋白胆固醇 [M(QR),mmol/L]	1.22(0.43)	1.12(0.33)	Z=-1.11	0.27

表1 两组一般资料比较

项目	轻度 (n=147)	中重度 (n=123)	统计值	P值
年龄[ $x -$ ±s,岁]	65.33±10.03	68.71±11.17	t=-2.60	0.01
性别[男,例(%)]	86(58.50)	87(70.70)	Z=4.35	0.04
吸烟[例(%)]	50(34.00)	49(39.80)	Z=0.99	0.32
高血压[例(%)]	94(63.90)	83(67.50)	Z=0.37	0.54
糖尿病[例(%)]	54(36.70)	46(37.40)	Z=0.01	0.91
H型高血压[例(%)]	52(35.37)	76(61.79)	Z=18.74	0.00
Hcy[M(QR),μmol/L]	11.45(3.99)	17.38(10.38)	Z=-9.32	0.00
收缩压( $x -$ ±s,mmHg)	150.63±19.14	153.78±21.81	t=-1.25	0.21
舒张压( $x -$ ±s,mmHg)	87.24±11.15	87.26±11.03	t=-0.02	0.99
葡萄糖[M(QR),mmol/L]	6.18(2.73)	6.39(2.85)	Z=-0.29	0.77
甘油三酯( $x -$ ±s,mmol/L)	1.81±0.78	1.76±0.83	t=0.52	0.60
胆固醇( $x -$ ±s,mmol/L)	4.33±0.91	4.36±0.76	t=-0.32	0.75
低密度脂蛋白胆固醇 ( $x -$ ±s,mmol/L)	3.01±0.79	3.00±0.73	t=0.07	0.95
高密度脂蛋白胆固醇 [M(QR),mmol/L]	1.22(0.43)	1.12(0.33)	Z=-1.11	0.27

表2 影响急性脑梗死早期神经功能缺损严重程度的多因素分析(n=270)

因素	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
因素	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
年龄	0.007	0.018	0.138	0.710	1.007	0.972	1.043
性别(男)	0.002	0.357	0.000	0.995	0.998	0.496	2.008
Hcy水平	0.320	0.062	26.745	0.000	1.377	1.220	1.554
H型高血压	2.308	0.726	10.107	0.001	0.099	0.024	0.413

图1 Hcy水平对急性脑梗死早期神经功能缺损严重程度的ROC曲线分析

表3 各亚组间早期神经功能缺损严重程度差异性比较[例(%)]

组别	例数	轻度卒中	中重度卒中	χ²值	P值
对照组	23	17(73.91)	6(26.09)^△	4.03	0.04
单纯高血压组	45	38(84.44)	7(15.56)^△	19.60	0.00
单纯高Hcy组	74	40(54.05)	34(45.95)^*#	0.16	0.93
H型高血压组	128	52(40.63)	76(59.37)^*#△	18.74	0.00

表4 高血压与高Hcy水平对LAA型ACI患者病情严重程度的交互作用

高血压	高Hcy	轻度(例)	中重度(例)	OR值
+	+	52	76	4.14
+	-	38	7	0.52
-	+	40	34	2.41
-	-	17	6	1.00

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