Study On Correlation Between Blood Pressure Variability And Early Neurological Deterioration And TCM Syndromes In Patients With Acute Ischemic Stroke

ObjectiveBlood pressure variability(BPV)is a risk factor for cerebrovascular disease independent of blood pressure level.BPV can lead to early neurological deterioration(END),and END is an important factor affecting the prognosis of patients with acute cerebral infarction(ACI).The purpose of this study was to explore :(1)the influencing factors of END.(2)The relationship between BPV and END.(3)the relationship between BPV and TCM syndromes.We tried to provide clinical evidence for blood pressure management in the early stage of cerebral infarction.MethodsA total of 399 acute ischemic stroke patients were included,enrolled in the emergency ward,neurology department and craniocerebral department and ICU of the First Affiliated Hospital of Guangzhou University of TCM from October 2018 to October 2020.General data,physical and chemical indexes,blood pressure data at admission and 72 hours after admission,NIHSS score,TCM syndrome type and other information of patients were collected.According to NIHSS score on admission and 72 hours after admission,they were divided into non-END group and END group.The differences in demographic characteristics,medical history,physical and chemical indexes,and vascular recanalization between the two groups were analyzed and compared.Univariate analysis and binary Logistic regression analysis were used to explore independent risk factors of END.Receiver operating curve(ROC)was used to analyze the predictive value of each independent risk factor for END.The mean,standard deviation(SD),coefficient of variation(CV),minimum(Min),lower quartile(Q1),Median(Median),upper quartile(Q3),maximum(Max)and range(R)of systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP)and pulse differential pressure(PP)were compared between the two groups.The rank-sum test of K independent samples was used to explore and analyze the relationship between TCM syndrome types of ischemic stroke and the above blood pressure indexes.Results(1)Univariate analysis showed that age,history of coronary heart disease and atrial fibrillation,NIHSS score at admission,serum homocysteine and white blood cell levels,TOAST classification,and surgical thrombotomy were suspected as influencing factors of END.(2)Logistic regression analysis showed that age(OR=1.028,95%CI:1.002-1.055)and admission NIHSS score(OR=1.151,95%CI: 1.088-1.217)were independent risk factors for END.(3)The ROC results showed that,among the above independent risk factors,only the area under curve(AUC)of NIHSS score was greater than 0.7,with truncation value of 7 and the AUC was 0.751.The sensitivity and specificity for predicting END were 63.2% and 74.9%,respectively.(4)SBP(sd),SBP(CV),SBP(median),SBP(Q3),SBP(Max),SBP(R),DBP(sd),DBP(CV),DBP(min),DBP(Max),DBP(R),MAP(sd),MAP(CV),MAP(Q3),MAP(Max),MAP(R),PP(scheme),PP(sd),PP(Q1),PP(median),PP(Q3),PP(Max),PP(R)variation in END group were significantly larger than those in non-END group.(5)There were significant differences among TCM syndromes regarding to admission SBP,DBP,MAP,PP and BPV parameters.In terms of admission blood pressure,the hyperactivity of liver Yang group was significantly higher than the phlegm and blood stasis group,the qi deficiency and blood stasis group,the phlegm and dampness group and the qi abatement group.In terms of SBP variation indexes,the mean value of liver Yang hyperactivity group was significantly higher than that of stagnation of phlegm and blood group and Yuan Qi abscission group.The standard deviation(SD),coefficient of variation(CV)and range of phlegm-stasis group were significantly lower than those of liver-yang hyperactivity group and phlegm-heat closed orifices group.With regard to DBP variation indexes,the mean value of the Yuanqi abatement group was significantly lower than that of the liver-yang hyperactivity group and the phlegm-heat group.SD,CV and the range of phlegm-heat group were significantly higher than those of phlegm-heat blocking orifices group.When speaking of MAP variation indexes,the mean value of MAP in the Yuanqi abatement group was significantly lower than that in the liver-yang hyperactivity group and the phlegm-heat blocking orifices group.MAP mean value,SD and the range of liver Yang hyperactivity group were significantly higher than those of phlegm and blood stasis group.The MAP SD,CV and the range of the phlegm-heat blocking orifices group were significantly higher than those of the phlegm-blood stasis group and the qi-deficiency and blood-stasis group.Only SD,CV and the range of PP in the liver Yang hyperactivity group and the phlegm-heat blocking orifices group were significantly higher than that in the phlegm-stasis group.Conclusion(1)Age and NIHSS score on admission were independent risk factors for END.(2)The blood pressure variability of END group was higher than that in non-END group.(3)BPV parameters were closely related to TCM syndromes.BP levels and BPV in the heat-positive syndrome groups were higher than those in the deficiency syndrome,phlegm-dampness syndrome and stasis syndrome groups.