急性缺血性卒中患者再灌注治疗后血压变异性与功能预后的相关性研究

doi:10.3969/j.issn.1673-5765.2025.10.008

摘要/Abstract

摘要： 目的评估急性缺血性卒中（acute ischemic stroke，AIS）患者再灌注治疗后全时段（急性期、亚急性期及家庭血压监测期）的血压变异性（blood pressure variability，BPV）与功能预后的相关性。
方法前瞻性连续纳入2022年7月—2023年10月北京市大兴区人民医院神经内科收治的接受再灌注治疗[静脉溶栓和（或）血管内治疗]的AIS患者。收集患者的人口学信息、既往病史、发病前mRS评分、入院NIHSS评分、发病至到院时间及入院后治疗信息等资料。监测患者自入院至再灌注治疗后3个月的血压，计算各阶段的BPV指标。根据3个月mRS评分，将患者分为功能预后良好（mRS评分0～2分）组和功能预后不良（mRS评分3～6分）组，比较两组的基线资料及BPV指标。采用多因素logistic回归分析评估各阶段BPV对AIS患者功能预后的影响。
结果共纳入218例患者，平均年龄为（63±12）岁，其中男性156例（71.6%）。功能预后良好组180例，功能预后不良组38例。与功能预后良好组相比，功能预后不良组急性期收缩压标准差更高[12.51（10.99～14.41）mmHg vs. 9.92（8.40～11.59）mmHg，P＜0.001]；亚急性期收缩压标准差更高[12.52（10.67～13.92）mmHg vs. 10.49（8.73～12.36）mmHg，P＜0.001]；家庭血压监测期收缩压标准差更高[9.02（8.11～12.61）mmHg vs. 6.61（5.53～7.92）mmHg，P＜0.001]；家庭血压监测期舒张压标准差更高[6.16（4.67～7.66）mmHg vs. 5.17（4.28～6.03）mmHg，P=0.005]。校正混杂因素后，多因素logistic回归分析显示，各阶段收缩压标准差升高均与3个月功能预后不良相关：急性期收缩压标准差（校正OR 1.17，95%CI 1.04～1.31，P=0.008），亚急性期收缩压标准差（校正OR 1.29，95%CI 1.06～1.57，P=0.013），家庭血压监测期收缩压标准差（校正OR 2.35，95%CI 1.54～3.59，P＜0.001），另外，家庭血压监测期舒张压标准差升高也与3个月功能预后不良相关（校正OR 1.85，95%CI 1.20～2.84，P=0.005）。BPV多个评估指标结果表现出相同的趋势。
结论 AIS患者再灌注治疗后，急性期、亚急性期及家庭血压监测期收缩压变异性升高可能增加3个月功能预后不良的风险。

文章导读： 在AIS急性期、亚急性期及出院后的长期家庭血压监测期中，BPV均可能对患者的功能预后产生影响，且这种影响有随着时间延长逐渐明显的趋势。因此，需要倡导建立从入院到家庭的全病程血压管理新模式。

关键词: 急性缺血性卒中; 再灌注治疗; 血压变异性; 功能预后; 家庭血压监测

Abstract: Objective To evaluate the correlation between blood pressure variability (BPV) across all phases (acute phase, subacute phase, and home blood pressure monitoring phase) and functional outcomes in acute ischemic stroke (AIS) patients after reperfusion therapy.
Methods AIS patients who underwent reperfusion therapy (intravenous thrombolysis and/or endovascular treatment) at the Department of Neurology, Beijing Daxing District People’s Hospital were prospectively and consecutively enrolled from July 2022 to October 2023. Demographic information, medical history, pre-onset mRS scores, admission NIHSS scores, onset-to-treatment time, and in-hospital treatment details were collected. Blood pressure was monitored from admission to 3 months after reperfusion therapy, and BPV indicators for each phase were calculated. Based on the 3-month mRS scores, patients were divided into a good functional outcome group (mRS score 0-2) and a poor functional outcome group (mRS score 3-6). Baseline characteristics and BPV indicators were compared between the two groups. Multivariate logistic regression analysis was performed to evaluate the effects of BPV at each phase on the functional outcomes of AIS patients.
Results A total of 218 patients were enrolled, including 156 males (71.6%), with a mean age of (63±12) years. There were 180 patients in the good functional outcome group and 38 patients in the poor functional outcome group. Compared with the good functional outcome group, the poor functional outcome group had a higher systolic blood pressure standard deviation in the acute phase [12.51 (10.99-14.41) mmHg vs. 9.92 (8.40-11.59) mmHg, P<0.001], a higher systolic blood pressure standard deviation in the subacute phase [12.52 (10.67-13.92) mmHg vs. 10.49 (8.73-12.36) mmHg, P<0.001], a higher systolic blood pressure standard deviation during the home blood pressure monitoring phase [9.02 (8.11-12.61) mmHg vs. 6.61 (5.53-7.92) mmHg, P<0.001], and a higher diastolic blood pressure standard deviation during the home blood pressure monitoring phase [6.16 (4.67-7.66) mmHg vs. 5.17 (4.28-6.03) mmHg, P=0.005]. After adjusting for confounding factors, multivariate logistic regression analysis showed that increased systolic blood pressure standard deviation at each phase was associated with poor functional outcomes at 3 months: systolic blood pressure standard deviation in the acute phase (adjusted OR 1.17, 95%CI 1.04-1.31, P=0.008), systolic blood pressure standard deviation in the subacute phase (adjusted OR 1.29, 95%CI 1.06-1.57, P=0.013), and systolic blood pressure standard deviation during the home blood pressure monitoring phase (adjusted OR 2.35, 95%CI 1.54-3.59, P＜0.001). All differences were statistically significant. An increased diastolic blood pressure standard deviation during the home blood pressure monitoring phase was also associated with poor functional outcomes at 3 months (adjusted OR 1.85, 95%CI 1.20-2.84, P=0.005). The results were consistent across multiple BPV indicators.
Conclusions Increased systolic blood pressure variability during the acute, subacute, and home blood pressure monitoring phases may increase the risk of poor functional outcomes at 3 months in AIS patients after reperfusion therapy.

Key words: Acute ischemic stroke; Reperfusion therapy; Blood pressure variability; Functional outcome; Home blood pressure monitoring

中图分类号:

尹梦鑫, 段春苗, 杨海华. 急性缺血性卒中患者再灌注治疗后血压变异性与功能预后的相关性研究[J]. 中国卒中杂志, 2025, 20(10): 1261-1269.

YIN Mengxin, DUAN Chunmiao, YANG Haihua. Correlation between Blood Pressure Variability and Functional Outcomes in Patients with Acute Ischemic Stroke after Reperfusion Therapy[J]. Chinese Journal of Stroke, 2025, 20(10): 1261-1269.

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