| Objective: Cerebrovascular disease is a frequently-occurring and common disease in the elderly.It has the characteristics of high morbidity,high recurrence rate,high disability rate and high mortality,which causes serious threat to human health and brings great burden to economic development and progress of human society.So,how to reduce the incidence of cerebral apoplexy and improve the prognosis of patients with cerebral apoplexy,has been the research hotspot issues in the world.Blood pressure variability(BPV),also known as blood pressure fluctuation,represents the degree of fluctuation in a certain period of time.BPV is the result of the dynamic adjustment of the neuroendocrine system and comprehensive balance of human body system.It is one of the most basic physiological characteristics of blood pressure.In recent years,studies have confirmed that it has a significant correlation between BPV and the prognosis of patients with acute cerebral infarction.BPV is an important factor that can independently predict the prognosis of patients with acute cerebral infarction.The purpose of this study was to observe the characteristics of 24-hour BPV in patients with acute cerebral infarction,analyze whether BPV in patients with different types of cerebral infarction is correlated,and further explore the relationship between BPV and3-month prognosis in patients with cerebral infarction.It is of great clinical significance to provide clinical basis for the treatment and prognosis of cerebrovascular diseases,so as to develop effective treatment programs,which will inevitably reduce the disability rate and mortality of ischemic cerebrovascular diseases,thus improving the quality of life of patients.Method: 241 patients with acute cerebral infarction within 24 hours of onset in department of neurology,Affiliated Hospital of Hebei University were selected(from September 2018 to December 2019).Basic information,previous medical history,NIHSS score at admission and relevant clinical data of each patient were recorded.The blood pressure of the patients was dynamically monitored 24 hours after admission,and the meanvalues,standard deviation(SD)and coefficient of variation(CV: equal to SD/ mean ×100%)of systolic and diastolic blood pressure were calculated.BPV is measured by SD and CV.According to the Chinese Ischemic Stroke Subclassification(CISS),patients with cerebral infarction were classified into two groups: the atherosclerosis group and the non-atherosclerosis group,and the correlation of BPV between the two groups was analyzed.What's more,the correlation between BPV in patients with atherosclerotic progressive cerebral infarction and non-progressive cerebral infarction was observed.The Modified Rankin score(MRS)was used to evaluate the prognosis of the patients 3 months after onset(MRS ?2 was classified as good prognosis,and MRS >2 was classified as poor prognosis).The clinical characteristics and blood pressure parameters of patients with good and poor prognosis in the atherosclerosis group were compared,and a binary Logistic regression model was established to analyze the relationship between BPV and prognosis.Results:1.There was no statistically significant difference in SD,CV and mean values of systolic blood pressure and diastolic blood pressure at 24 hours between the atherosclerosis group and the non-atherosclerosis group(P>0.05).2.Compared with non-progressive cerebral infarction patients in the atherosclerosis group,SD,CV and mean values of 24 h diastolic blood pressure in the progressive cerebral infarction group were higher than those in the non-progressive cerebral infarction group,but there was no statistical significance(P>0.05).The SD,CV and mean values of 24 h systolic blood pressure in the progressive cerebral infarction group were significantly higher than those in the non-progressive cerebral infarction group,with statistically significant differences(P<0.05).3.There was no significant difference in age,gender,preexisting hypertension,coronary heart disease,stroke and hyperlipidemia between the group with good prognosis and the group with poor prognosis(P>0.05).There was no significant difference in smoking or drinking between the two groups.However,the history of diabetes was correlated with thepoor prognosis of patients with acute cerebral infarction,with statistical significance(P<0.05).The average NIHSS score at admission of the patients in the poor prognosis group was5.61±3.84 points,and the average NIHSS score at admission of the patients in the good prognosis group was 3.03±2.01 points.The difference in NIHSS score between the two groups was statistically significant(P< 0.05).4.The good prognosis and poor prognosis group of 24 h average systolic blood pressure,the SD,CV and mean values of diastolic blood pressure difference is no statistical significance(P>0.05).But the 24 h systolic blood pressure SD(14.75±3.46mmHg)and systolic blood pressure CV(10.41±2.18mmHg)in the poor prognosis group were significantly higher than those in the good prognosis group,and the difference was statistically significant(P <0.05).5.After multi-factor adjustment,it was suggested that the significant variables in the final model were: diabetes history,NIHSS score,and 24 h systolic blood pressure SD.After controlling for other confounding factors,the risk of poor prognosis increased with the increase of NIHSS score on admission(OR=1.473,95%CI:1.250-1.737,P< 0.001),indicating that NIHSS score was a risk factor influencing the prognosis of patients.In addition,the history of diabetes(OR=3.650,95%CI:1.542-8.643,P=0.003)was also an independent risk factor affecting the prognosis of patients in 3 months.The non-diabetic group was taken as the baseline group,and the risk of poor prognosis in the diabetic group was 3.650 times higher than that in the baseline group.After controlling for other confounding factors,the greater the 24 h systolic blood pressure SD,the greater the risk of poor prognosis(OR=1.202,95%CI:1.087-1.329,P<0.001).Conclusion:1.There was no significant difference in BPV between patients with atherosclerotic and non-atherosclerotic cerebral infarction.2.Patients with atherosclerotic progressive cerebral infarction were closely related to the increase of 24 h systolic blood pressure variability.3.Poor prognosis at 3 months in patients with atherosclerotic cerebral infarction was significantly correlated with increased 24 h blood pressure variability,and 24 h systolic blood pressure SD and CV were more valuable for the prognosis of patients than average blood pressure.At the same time,NIHSS score and diabetes history were risk factors to assess the prognosis of patients.Increased 24 h systolic blood pressure variability is an independent risk factor for poor prognosis in patients with acute cerebral infarction. |
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