李齐光 陈培松 梁雅茹

[摘要]目的 探討原发性高血压并发脑梗死发生的危险因素。方法 选取2016年1月～2018年7月中山大学附属第一医院神经内科收治的377例初次诊断为原发性高血压的住院患者，根据是否并发脑梗死将其分为高血压并发脑梗死组（114例）和单纯高血压组（263例）。选取同期109例体检正常者作为健康对照组。采用单因素分析对所有研究者的收缩压、舒张压和冠心病占比等一般临床资料以及尿素氮（BUN）、碱性磷酸酶（ALP）、同型半胱氨酸（Hcy）、白细胞计数（WBC）、血小板计数（PLT）、纤维蛋白原（Fbg）、超敏C反应蛋白（hs-CRP）和D-二聚体（D-D）等实验室指标进行评估。通过多因素分析确定高血压并发脑梗死发生的危险因素。结果 单因素分析结果显示，高血压并发脑梗死组的收缩压、舒张压、冠心病占比、BUN、ALP、Hcy、WBC、Fbg、hs-CRP和D-D水平均高于单纯高血压组和健康对照组，而PLT水平则低于单纯高血压组和健康对照组，差异有统计学意义（P<0.05）。多因素分析结果显示，ALP（β=0.61，OR=1.88，95%CI：1.38～2.61）、Hcy（β=0.37，OR=1.62，95%CI：1.17～2.25）、Fbg（β=0.53，OR=1.85，95%CI：1.35～2.52）是高血压并发脑梗死的危险因素（P<0.05）。结论 ALP、Hcy和Fbg均是高血压并发脑梗死的危险因素，对于临床评估脑梗死的发作具有重要临床意义。

[关键词]碱性磷酸酶;同型半胱氨酸;纤维蛋白原;高血压并发脑梗死

[中图分类号] R743          [文献标识码] A          [文章编号] 1674-4721（2020）6（b）-0012-05

[Abstract] Objective To explore the risk factors of the occurrence of essential hypertension complicated with cerebral infarction. Methods A total of 377 hospitalized patients with primary diagnosis of essential hypertension who were admitted to the Department of Neurology in the First Affiliated Hospital of Sun Yat-sen University from January 2016 to July 2018 were selected in the study. They were divided into hypertensive complicated cerebral infarction group （114 cases） and simple hypertensive group （263 cases） according to whether they were complicated with cerebral infarction. Another 109 cases with normal physical examination during the same period were selected as the healthy control group. Univariate analysis was used to analyze general clinical data such as systolic blood pressure， diastolic blood pressure， and coronary heart disease proportion of all researchers as well as urea nitrogen （BUN）， alkaline phosphatase （ALP）， homocysteine （Hcy）， white blood cell count （WBC）， platelet count （PLT）， fibrinogen （Fbg）， high-sensitivity C-reactive protein （hs-CRP） and D-dimer （D-D） and other laboratory indicators for evaluation. By multivariate analysis， the risk factors for hypertension complicated with cerebral infarction were determined. Results Univariate analysis showed that systolic blood pressure， diastolic blood pressure， the proportion of coronary heart disease， and the levels of BUN， ALP， Hcy， WBC， Fbg， hs-CRP and D-D in the hypertensive complicated cerebral infarction group were higher than those in the simple hypertension group and healthy control group， while the level of PLT was lower than that in the simple hypertension group and healthy control group， the differences were statistically significant （P<0.05）. Multivariate analysis results showed that ALP （β=0.61， OR=1.88， 95%CI： 1.38-2.61）， Hcy （β=0.37， OR=1.62， 95%CI： 1.17-2.25）， Fbg （β=0.53， OR=1.85， 95%CI： 1.35-2.52） were risk factors for hypertension complicated with cerebral infarction （P<0.05）. Conclusion ALP， Hcy and Fbg are the risk factors for hypertension complicated with cerebral infarction， which are important for clinical evaluation of cerebral infarction.

[Key words] Alkaline phosphatase; Homocysteine; Fibrinogen; Hypertension complicated with cerebral infarction

目前在世界范围内，心血管疾病是致残和死亡的主要原因[1]。高血压是最常见的心血管疾病之一，可导致大脑、心脏、肾脏、视网膜和血管等多种靶器官的损伤，其中脑梗死是最常见的并发症，由于其高发病率和高复发率，给我国的医疗资源造成了巨大的负担[2]，能够早期识别潜在的脑梗死患者，帮助临床医生及时诊断脑梗死、及早干预脑梗死的进展是患者预后良好的重要前提。……