动脉-动脉栓塞性缺血性卒中患者晨峰血压与颈动脉溃疡斑块的相关性研究  

Association of Morning Blood Pressure Surge with Carotid Artery Plaque Ulceration in Ischemic Stroke Patients with Pathogenesis of Artery to Artery Embolism

作　　者：程伟[1] 包艳娥[2] 聂莉[1] 李婉秋[1] 乔向亮[1] 程晓玲[1] 

机构地区：[1]湖北医药学院附属随州市中心医院神经内科,随州441300 [2]湖北医药学院附属随州市中心医院心内科

出　　处：《中国卒中杂志》2013年第8期603-607,共5页Chinese Journal of Stroke

摘　　要：目的在动脉-动脉栓塞性缺血性卒中患者中,探讨晨峰高血压与颈动脉溃疡斑块的相关性。方法连续入组120例经中国缺血性卒中亚型(Chinese Ischemic Stroke Subclassification, CISS)分型诊断为动脉-动脉栓塞性缺血性卒中患者,利用24h动态血压监测以及颈动脉彩超分别监测晨峰血压及颈动脉溃疡斑块。利用Logistic回归模型,研究晨峰血压与颈动脉溃疡斑块的相关性。结果 120例缺血性卒中患者的平均年龄为(62.6±12.8)岁,女性占36.8%。晨峰高血压组(n=48)溃疡斑块的检出率与无晨峰高血压组(n=72)相比,差异无显著性(31.3%vs30.6%,P=0.84)。进一步将溃疡斑块按照检出部位(出现在卒中病灶同侧颈动脉或对侧颈动脉)进行分类发现,晨峰高血压组病灶同侧溃疡斑块的检出率明显高于无晨峰高血压组(27.1%vs19.4%,P=0.008)。多因素分析的结果显示,在调整了年龄、性别之后,晨峰高血压与病灶同侧溃疡斑块的相关性具有统计学意义[优势比(oddsratio,OR):1.42;95%可信区间(confidenceinterval,CI):1.09～4.22)];进一步校正其他危险因素之后,两者相关性仍存在(OR1.23;95%CI1.02～3.46)。结论在动脉-动脉栓塞性缺血性卒中患者中,晨峰高血压与卒中病灶同侧颈动脉溃疡斑块的检出率具有相关性,提示过高的晨峰血压可能是颈动脉溃疡斑块脱落导致动脉-动脉栓塞型缺血性卒中发病的危险因素。Objective To investigate the association of morning blood pressure surge （MBPS） with carotid artery plaque ulceration （CAPU） in ischemic stroke （IS） patients. Methods One hundred and twenty IS patients diagnosed with artery to artery embolism based on Chinese Ischemic Stroke Subclassification （CISS） were enrolled in this study. MBPS was monitored by ambulatory blood pressure monitoring within 24 hours, and CAPU was examined by carotid ultrasonography. The association of MBPS with CAPU was evaluated by the Logistic regression model. Results The mean age of the total 120 IS patients was （62.6±12.8） years old, and 36.8% was female. Compared with the MBPS- group （n=72）, the MBPS＋ group （n=48） did not have higher detection rate of CAPU （31.3% vs 30.6%, P=0.84）. After separation of ipsilateral CAPU and contralateral CAPU, we found the detection rate was higher in MBPS＋ group than MBPS- group （27.1% vs 19.4%, P=0.008）. The multivariate analysis showed that MBPS was associated with ipsilateral CAPU （odds ratio[OR], 1.42; 95%confidence interval[CI], 1.09-4.22） after adjusting for age and sex. The association still existed after further adjusting for other risk factors （OR 1.23; 95%CI 1.02±3.46）. Conclusion MBPS is associated with ipsilateral CAPU in the IS patients with pathogenesis of artery to artery embolism, which implies that higher MBPS may contribute to the fall of plaque that led to the occurrence of artery to artery embolism.

关 键 词：晨峰血压 颈动脉溃疡斑块 缺血性卒中 

分 类 号：R743.3[医药卫生—神经病学与精神病学]