雍心愿 张惠丽 张换

[摘要] 目的 探討血压变异性及左房内径与原发性高血压合并脑梗死复发的相关性。 方法 选择2016年10月～2017年10月我院收治的原发性高血压合并脑梗死患者149例，根据其此次脑梗死是否为初次发生，分为A组（初发组）78例，B组（复发组）71例，对两组患者的24 h、日间、夜间血压平均值和血压变异性进行统计检验；以血压变异性、LADI为自变量，采用Logistic回归分析脑梗死复发的影响因素。 结果 两组患者平均血压比较，B组24 h、日间SBP和24 h、日间、夜间DBP均高于A组，差异有统计学意义（P<0.05）；两组患者血压变异性及LADI比较，B组 24 h SBPV、日间SBPV、24 h DBPV、LADI均高于A组，差异有统计学意义（P<0.05）；Logistic回归分析结果显示，BMI、LADI、24hDBPV、日间SBPV、日间DBPV是脑梗死复发的危险因素。 结论 平均血压升高与脑梗死复发具有相关性，BMI、LADI、24hDBPV、日间SBPV、日间DBPV是脑梗死复发的危险因素。

[关键词] 原发性高血压；复发性脑梗死；血压变异性；左室内径；左房内径指数

[中图分类号] R544.1 [文献标识码] A [文章编号] 1673-9701（2018）15-0025-04

Associations of blood pressure variability and internal diameter of left atrium with recurrent cerebral infarction

YONG Xinyuan1 ZHANG Huili1 ZHANG Huan2

1.Department of Neurology， the First Affiliated Hospital of the Medical College， Shihezi University， Shihezi 832000， China； 2.Department of Emergency， the Central Hospital of Zhoukou City in Henan Province， Zhoukou 466000， China

[Abstract] Objective To investigate the associations of blood pressure variability（BPV） and internal diameter of left atrium with primary hypertension accompanied with recurrent cerebral infarction（CI）. Methods Patient with primary hypertension accompanied with recurrent CI in the first affiliated hospital of the medical college， Shihezi university from October 2016 to October 2017 were collected. Patients were divided into group A（first attack group， 78 patients） and group B（recurrence group， 71 patients） according to whether the CI attacked for the first time. Statistical tests were performed to test the average values of blood pressure of 24 h， daytime and nighttime and BPV. Setting BPV and LADI as independent variables， logistic regression analysis was used to analyze the influential factors of the CI recurrence. Results SBP of 24 h and daytime as well as DBP of 24 h， daytime and nighttime in group B were statistically higher than those in group A （P<0.05）. SBPV of 24 h， SBPV of daytime， DBPV of 24 h and LADI in group B were statistically higher than those in group A（P<0.05）. The results of Logistic regression analysis showed BMI， LADI， DBPV of 24 h， SBPV of daytime and DBPV of daytime were the risk factors of the recurrence of CI. Conclusion Increase in average blood pressure was associated with the recurrence of CI， BMI， LADI， DBPV of 24 h， SBPV of daytime and DBPV of daytime were the risk factors of the recurrence of CI.

[Key words] Primary hypertension； Recurrent cerebral infarction； Blood pressure variability； Internal diameter of left ventricle； Index of left atrium internal diameter

脑卒中危害极大，其发病率、死亡率、致残率、复发率均较高，是目前我国三大死亡原因之一[1]。国内外的众多指南均将高血压视为脑卒中的首要危险因素。70%左右脑卒中为脑梗死。即便日常血压正常，有时暂时血压升高亦可诱发脑卒中，这是血压变异性所致，说明血压变异会引起心脑血管、肾脏等靶器官的损害[2]。近年来，随着24 h动态性血压监测的普及，血压变异性越来越受到临床重视，与血压平均值相比，血压变异性与脑卒中的相关性更强，血压变异性增加可增加缺血性脑卒中的发生机率[3]。在高血压靶器官损害中，左房扩大往往会早于左室肥厚的出现，已有研究证实，左房扩大可以很好地预测心血管事件[4]。本研究收集原发性高血压合并脑梗死患者，收集其血压变异性、左房内径等，以复发性脑梗死患者为实验组，以初發脑梗死患者为对照组，分析血压变异性（BPV）、左房内径指数（LADI）与脑梗死复发的相关性。……