早期降压治疗对不同TOAST分型的急性缺血性脑卒中患者1年结局的影响

Effect of early antihypertensive therapy on 1-year outcome of acute ischemic stroke after TOAST classification

摘要:

目的 讨论早期降压治疗对不同类肝素药物治疗急性脑卒中试验(TOAST)分型的急性缺血性脑卒中患者1年结局的影响。方法 收集2009年8月至2013年5月在解放军第九六〇医院泰安院区和肥城市人民医院住院治疗的发病48h内伴有高血压的急性缺血性脑卒中非溶栓患者597例。依据TOAST分型分为:大动脉粥样硬化型卒中(LAA)261例,心源性栓塞型卒中(CE)91例,小动脉闭塞型卒中(SAO)225例,其他类型20例。将各分型患者分别分为2组:LAA降压组(n=126)和LAA非降压组(n=135)；CE降压组(n=46)和CE非降压组(n=45)；SAO降压组(n=115)和SAO非降压组(n=110)；其他类型降压组(n=7)和其他类型非降压组(n=13)。降压组24h内降压10%~20%。观察患者出院后1年的死亡率、死亡/致残率及卒中复发率。采用SPSS 20.0软件进行统计分析。2组间比较采用t检验或χ²检验。结果 随访1年结果显示,在LAA、SAO和其他类型卒中分型中,降压组和非降压组患者1年后的死亡率、死亡/致残率及卒中复发率差异均无统计学意义(P＞0.05)；在CE分型中,降压组患者1年后的死亡/致残率显著低于非降压组(45.6%和66.7%,P＜0.05),但1年死亡率及卒中复发率与对照组相比差异无统计学意义(P＞0.05)。结论 急性期降压治疗对LAA、SAO型缺血性脑卒中患者1年结局无显著影响,但可显著降低CE型缺血性脑卒中患者的1年死亡/致残率。

Abstract:

Objective To determine the effect of early antihypertensive therapy on 1-year outcome of the acute ischemic stroke patients categorized by Trial of Org 10172 in Acute Stroke Treatment (TOAST). Methods A total of 597 hypertension patients with image-diagnosed ischemic stroke (without thrombolysis treatment) within 48 h of disease onset admitted to Tai′an Branch of Chinese PLA Hospital No.960 and Feicheng People′s Hospital from August 2009 to May 2013 were recruited in this study. According to TOAST classification, they were assigned into large artery atherosclerosis subtype (LAA group, n=261), cardio-embolism subtype (CE group, n=91), small artery occlusion subtypes (SAO group, n=225) and other subtypes (n=20). Then every subtype group was further divided into the antihypertension (AH) treatment subgroup and the non-antihypertension (non-AH) treatment subgroup, with those of LAA group containing 126 cases in the former and 135 cases in the latter subgroups, those of CE group containing 46 and 45 cases, those of SAO group containing 115 and 110 cases, and those of other subtypes containing 7 and 13 cases, respectively. In all the AH subgroups, blood pressure must be decreased by 10% to 20% within 24 h of enrollment. The mortality, mortality/disability rate and recurrence rate were evaluated at one year after discharge. SPSS statistics 20.0 software was used for statistical analysis, and Student′s t test or Chi-square test was employed for comparison between the two groups. Results The results of 1-year follow-up showedthat there were no statistical differences in mortality, mortality/disability rate and recurrence rate between the AH and non-AH subgroups from the LAA, SAO and other subtypes groups (P>0.05). In the CE group, the 1-year mortality/disability rate was significantly lower in the AH than the non-AH treatment subgroups (45.6% vs 66.7%, P<0.05), while no such differences were seen in 1-year mortality and stroke recurrence rate between the two subgroups (P>0.05). Conclusion Antihypertensive therapy in the acute phase after ischemic stroke shows no obvious effect on 1-year outcome in the LAA and SAO patients, but it can effectively reduce the 1-year mortality/disability rate for the CE patients.