急性缺血性脑卒中TOAST分型后早期降压治疗对3个月结局的影响

目的探讨TOAST分型与急性缺血性脑卒中急性期降压治疗预后的关系。方法收集2009年8月~2013年5月在解放军第九六○医院(泰安院区)、肥城市人民医院、东平县人民医院住院的缺血性脑卒中合并高血压、非溶栓患者416例,大动脉粥样硬化型(large artery atherosclerosis,LAA)组168例,降压治疗82例,无降压治疗86例;心源性栓塞型(cardioembolism,CE)组84例,降压治疗43例,无降压治疗41例;小动脉闭塞型(small artery occlusion,SAO)组144例,降压治疗74例,无降压治疗70例;其他病因明确型(10例)和病因不明型组(10例)样本数太少,未做统计学分析。观察患者出院后3个月全因病死率、死亡/致残率。结果LAA组、CE组和SAO组降压治疗患者治疗2周或出院时血压下降幅度明显高于无降压治疗患者,差异有统计学意义(P<0.05,P<0.01)。随访3个月,LAA组降压治疗患者病死率明显高于无降压治疗患者(13.4%vs 3.5%,P=0.041),CE组降压治疗患者病死率明显低于无降压治疗患者(14.0%vs 34.1%,P=0.030),SAO组降压治疗与无降压治疗患者病死率比较,差异无统计学意义(1.4%vs 2.9%,P=0.961)。LAA组、CE组和SAO组死亡/残疾率比较,差异无统计学意义(46.3%vs 39.5%,51.2%vs 70.7%,20.3%vs 20.0%,P>0.05)。结论LAA缺血性脑卒中急性期降压有增加3个月病死率风险;CE缺血性脑卒中急性期应避免血压维持在较高水平,降压治疗是获益的;SAO缺血性脑卒中急性期降压治疗未改变其3个月死亡结局。

Effect of early antihypertensive treatment on 3-month outcome of acute ischemic stroke after TOAST classification

Objective To study the association between TOAST classification and outcome of early antihypertensive treatment on acute ischemic stroke(AIS).Methods Four hundred and sixteen AIS patients with hypertension admitted to Chinese PLA No.960 Hospital,Feicheng People’s Hospital and Dongping County People’s Hospital from August 2009 to August 2013 were divided into large artery atherosclerosis(LAA)group(n=168)with 82 received antihypertensive treatment and 86 received no antihypertensive treatment,cardioembolism(CE)group(n=84)with 43 received antihypertensive treatment and 41 received no antihypertensive treatment,small artery occlusion(SAO)group(n=144)with 74 received antihypertensive treatment and 70 received no antihypertensive treatment,known etiology group(n=10)and unkonown etiology group(n=10).Their all-cause mortality and death/disability ratio were recorded at 3 months after discharge.Results The decreased amplitude of blood pressure was significantly higher in LAA group,CE group and SAO group than in non-antihypertensive treatment group after 2 weeks of treatment or discharge(P<0.05,P<0.01).The mortality was significantly higher in LAA group and was significantly lower in CE group after antihypertensive treatment than before antihypertensive treatment(13.4%vs 3.5%,P=0.041;14.0%vs 34.1%,P=0.030).No significant difference was detected in mortality of SAO group and in mortality/disability ratio of LAA group,CE group and SAO group after and before antihypertensive treatment(1.4%vs 2.9%,P=0.961;46.3%vs 39.5%,51.2%vs 70.7%,20.3%vs 20.0%,P>0.05).Conclusion The 3-month mortality increases during the early antihypertensive treatment of LAA-type ischemic stroke.The blood pressure should be controlled during the early antihypertensive treatment of CE-type ischemic stroke.Early antihypertensive treatment of LAA-type ischemic stroke can not change its 3-month outcome.