高血压患者血清瘦素异常表达及动态血压参数对脑梗死复发和预后不良的预测  

Predictive values of abnormal serum leptin and ambulatory BPV for recurrent CI and poor prognosis in patients with hypertension

作　　者：范永新[1] 闫凤[1] 刘娟[1] 朱月敏[1] 刘猛[1] 尹航[2] Fan Yongxin;Yan Feng;Liu Juan;Zhu Yuemin;Liu Meng;Yin Hang(First Department of Neurology,Zhuozhou Hospital,Baoding 072750,Hebei Province,China)

机构地区：[1]涿州市医院神经内一科,072750 [2]保定市第二中心医院急诊科

出　　处：《中华老年心脑血管病杂志》2023年第1期8-12,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：保定市科技计划项目(2141ZF177)。

摘　　要：目的研究老年高血压患者血清瘦素异常表达及动态血压参数对脑梗死复发和预后不良的预测。方法选取2019年6月至2022年1月涿州市医院神经内一科和保定市第二中心医院急诊科治疗的高血压合并脑梗死患者230例为脑梗死组,同期在涿州市医院神经内一科和保定市第二中心医院急诊科行身体检查的60例健康志愿者为对照组,采集平均血压和血压变异性等参数,血压变异性参数包括24 h收缩压变异性(24 h SBPV)和24 h舒张压变异性(24 h DBPV),采用酶联免疫吸附法测定血清瘦素水平,随访3个月,失访4例,脑梗死组复发49例,预后不良患者90例,采用多因素logistic回归分析脑梗死复发和预后不良的影响因素。结果脑梗死组血清瘦素、24 h收缩压、24 h舒张压、24 h SBPV和24 h DBPV明显高于对照组(P<0.01)。脑梗死组复发患者血清瘦素、24 h收缩压、24 h舒张压、24 h SBPV和24 h DBPV明显高于非复发患者(P<0.05,P<0.01)。脑梗死组预后不良患者血清瘦素、24 h收缩压、24 h舒张压、24 h SBPV和24 h DBPV明显高于预后良好患者(P<0.01)。多因素logistic回归分析显示,血清瘦素、24 h收缩压、24 h舒张压、24 h SBPV和24 h DBPV是脑梗死复发的影响因素(P<0.05,P<0.01)。5项指标联合诊断脑梗死复发和预后不良的ROC曲线下面积分别为0.893(95%CI:0.816~0.970),0.951(95%CI:0.918~0.985)。结论老年高血压患者血清瘦素和动态血压参数在脑梗死复发和预后不良中异常高表达,且其单独和联合回归检测可有效预测和诊断脑梗死复发或预后不良。Objective To study the expression of abnormal serum leptin and ambulatory blood pressure parameters in elderly patients with hypertension in the diagnosis and prediction of recurrent cerebral infarction(CI)and poor prognosis.Methods A total of 230 patients with hypertension complicated with CI treated in the First Department of Neurology of Zhuozhou Hospital and the Department of Emergency of Baoding Second Central Hospital from June 2019 to January 2022 were recruited in this study.Another 60 healthy volunteers who taking physical examination in above 2 hospitals during the same period served as control group.Blood pressure variability included 24-hour systolic blood pressure variability(24-h SBPV)and 24-hour diastolic blood pressure variability(24-h DBPV)were collected.Serum leptin level was measured with ELISA.In 3 months of follow-up,4 patients were lost,and 49 patients had CI relapsed and 90 patients had poor prognosis.Multivariate logistic regression analysis was used to analyze the influencing factors of recurrent CI and poor prognosis.Results Serum leptin level,24-h SBP,24-h DBP,24-h SBPV and 24-h DBPV in the CI group were significantly higher than those in the control group(P<0.01).While,the above 5 inidcators were significantly higher in the recurrent CI group than the non-recurrent CI group(P<0.05,P<0.01),and were greatly better in the patients with poor prognosis than those with good prognosis(P<0.01).Logistic regression analysis showed that these 5 indicators were influencing factors of CI recurrence and poor prognosis(P<0.05,P<0.01).The area under the ROC curve of the 5 indicators combined in the diagnosis of recurrent CI and poor prognosis were 0.893(95%CI:0.816-0.970)and 0.951(95%CI:0.918-0.985),respectively.Conclusion Serum leptin and ambulatory blood pressure parameters are abnormally high in recurrent CI patients and poor prognosis patients,and their single and combined regression detection can effectively predict and diagnose recurrent CI or poor prognosis.

关 键 词：高血压 瘦素 脑梗死 复发 

分 类 号：R544.1[医药卫生—心血管疾病] R743.33[医药卫生—内科学]