合并红细胞增多症对高原高血压患者脑出血风险的影响  

Research on the effects of complicated polycythemia on the risk of cerebral hemorrhage in patients with high altitude hypertension

作　　者：炜桑[1] 小平措[2] Wei Sang;Xiao Pingcuo(Department of Alpine Diseases,General Hospital of Tibet Military Command,Tibet Autonomous Region,Lasa 850000,China)

机构地区：[1]西藏军区总医院高山病科,西藏拉萨850000 [2]西藏军区总医院神经科,西藏拉萨850000

出　　处：《海军医学杂志》2020年第6期681-684,共4页Journal of Navy Medicine

摘　　要：目的探究红细胞增多症(PV)对高原高血压患者脑出血风险的影响。方法回顾性分析西藏军区总医院2018年4月至2019年4月间收治的150例高原高血压患者临床资料,根据是否合并PV分为观察组(n=54,合并PV)和对照组(n=96,未合并PV)。比较2组患者24 h心率和动态血压及凝血功能指标水平,记录2组患者脑出血发生率,并分析血红蛋白(Hb)对预测高原高血压合并PV患者发生脑出血风险的价值。结果观察组24 h平均心率和24 h夜间相邻(RR)间期之差均方根(rMSSD)低于对照组,24 h正常RR间期标准差(SDNN)和24 h每5 min节段平均正常RR间期标准差(SDANN)均高于对照组(P<0.05)。观察组24 h收缩压(SBP)和24 h舒张压(DBP)均高于对照组,夜间收缩压下降百分比(ΔSBP)、舒张压下降百分比(ΔDBP)及杓型血压率均低于对照组(P<0.05)。观察组活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)均小于对照组,纤维蛋白原(Fib)高于对照组(P<0.05)。观察组脑出血28例,对照组26例,2组脑出血发生率差异具有统计学意义(P<0.05)。受试者工作曲线(ROC)分析显示Hb预测伴有PV的高原高血压患者发生脑出血的曲线下面积(AUC)为0.790,灵敏度为0.907。结论合并PV将显著增加高原高血压患者脑出血风险,可能与其造成心率和血压节律失调有关,监测Hb有助于判断脑出血风险,为临床诊疗提供依据。Objective To study the effects of polycythemia(PV)on the risk of cerebral hemorrhage in patients with high altitude hypertension.Methods Retrospective analysis was made in the clinical data of 150 patients with high altitude hypertension admitted and treated in the General Hospital from April 2018 to April 2019.The patients were divided into the observation group(n=54)and the control group(n=96),depending on whether or not they were complicated with PV.The 24-hour heart rate,dynamic blood pressure and blood coagulation indicators were compared between the 2 groups,and the rate of cerebral hemorrhage was also recorded.Finally,analysis was made on the value of hemoglobin(Hb)in predicting the risk of cerebral hemorrhage in patients with high altitude hypertension complicated with PV.Results The 24-hour mean heart rate and the adjacent RR interval at night(rMSSD)in the observation group were lower than those in the control group.The standard deviation of 24-hour normal RR interval(SDNN)and standard deviation of average RR interval in 5-min segments of 24 hours(SDANN)every 5 minutes were higher than those of the control group,with statistical significance(P<0.05).The systolic pressure(SBP)and diastolic pressure(DBP)within 24 hours in the observation group were significantly higher than those of the control group.The rate of decrease in systolic blood pressure(ΔSBP),the diastolic blood pressure(ΔDBP)and dipper type blood pressure rate at night were lower than those in the control group,also with statistical significance(P<0.05).The activated partial thromboplastin time(APTT),prothrombin time(PT)and thrombin time(TT)of the observation group were all significantly shorter than those of the control group,and the fibrinogen(Fib)of the observation group was higher than that of the control group,all with statistical significance(P<0.05).There were 28 cases of cerebral hemorrhage in the observation group and 26 cases in the control group,and there were no significant differences in the rate of cerebral hemorrhage,when compa

关 键 词：红细胞增多症 高原高血压 脑出血 风险因素 

分 类 号：R544.1[医药卫生—心血管疾病]