糖尿病和非糖尿病的缺血性卒中患者血压昼夜节律与预后的关系

doi:10.3969/j.issn.1006-7795.2016.01.013

首都医科大学学报 ›› 2016, Vol. 37 ›› Issue (1): 62-69.doi: 10.3969/j.issn.1006-7795.2016.01.013

• 心脑血管疾病临床与基础研究 • 上一篇下一篇

糖尿病和非糖尿病的缺血性卒中患者血压昼夜节律与预后的关系

田俊萍¹, 王鸿², 王红霞³, 赵性泉⁴, 陈步星¹

1. 首都医科大学附属北京天坛医院心内科, 北京 100050;
2. 航天中心医院内分泌科, 北京 100049;
3. 首都医科大学附属北京石景山医院心内科, 北京 100043;
4. 首都医科大学附属北京天坛医院神经内科, 北京 100050

收稿日期:2015-12-10 出版日期:2016-02-21 发布日期:2016-02-01
通讯作者: 陈步星 E-mail:chbux@126.com
基金资助:
国家重点基础研究发展计划项目(2011CB504102, 2012CB722407),国家自然科学基金(81371398),北京市自然科学基金(7131001),北京市创新团队建设提升计划(IDHT20140514),北京脑重大疾病研究院项目(BIBD-PXM2013 014226 07 000084),首都医科大学校基金(2015JS21)。

Relationship between circadian blood pressure rhythms and outcome in diabetic and nondiabetic patients with ischemic stroke

Tian Junping¹, Wang Hong², Wang Hongxia³, Zhao Xingquan⁴, Chen Buxing¹

1. Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China;
2. Department of Endocrinology, Aerospace Center Hospital, Beijing 100049, China;
3. Department of Cardiology, Beijing Shijingshan Hospital, Capital Medical University, Beijing 100043, China;
4. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China

Received:2015-12-10 Online:2016-02-21 Published:2016-02-01
Supported by:
This study was supported by Major State Basic Research Development Program of China (2011CB504102, 2012CB722407), National Natural Science Foundation of China (81371398),Natural Science Foundation of Beijing (7131001), The Project of Construction of Innovative Teams and Teacher Career Development for Universities and Colleges Under Beijing Municipality (IDHT20140514),Beijing Institute for Brain Disorders-PXM (BIBD-PXM2013 014226 07 000084), Science Foundation of Capital Medical University(2015JS21).

摘要/Abstract

摘要： 目的探讨糖尿病和非糖尿病的缺血性卒中患者的血压昼夜节律与心脑血管预后的关系。方法入选2010年5月至2011年8月首都医科大学附属北京天坛医院脑血管病中心缺血性卒中住院患者373例,所有患者均为TOAST(trial of org 10172 in acute stroke treatment)分型大动脉粥样硬化型。记录患者的基线资料,行动态血压监测并随访。终点事件包括卒中复发、心脑血管事件和心脑血管死亡。结果 367例患者资料纳入分析。根据血压昼夜模式分为杓型组(76例)和非杓型组(291例),随访(19.0±5.0)个月。非杓型组患者的夜间收缩压、夜间舒张压、心脑血管事件发生率均高于杓型组(P<0.05)。Kaplan-Meier生存分析显示非杓型组患者无心脑血管事件的生存数值上低于杓型组,但差异无统计学意义(P=0.052)。根据有无糖尿病分层分析,在非糖尿病亚组,Kaplan-Meier分析未观察到血压昼夜模式与预后的相关性(P=0.763);然而,在糖尿病亚组,Kaplan-Meier分析显示非杓型患者无心脑血管事件的生存显著低于杓型患者(P=0.030)。Cox回归显示高龄(HR=1.037, 95%CI:1.008~1.067, P=0.013)、糖尿病(HR=2.406, 95%CI:1.340~4.319, P=0.003)、高的入院改良Rankin评分法评分(modified Rankin Scale,mRS)(HR=1.379, 95%CI:1.143~1.664, P=0.001)、收缩压夜间血压下降率(非杓型)(HR=0.964, 95%CI:0.928~1.001, P=0.056)是卒中患者不良心脑血管事件的预测因素(P<0.05)。结论血压昼夜节律异常是糖尿病的缺血性卒中患者不良心脑血管预后的预测因素,而在非糖尿病的卒中患者却未发现血压昼夜节律与预后的相关性。

关键词: 卒中, 缺血性, 糖尿病, 血压昼夜节律, 预后

Abstract: Objective To investigate the association between circadian blood pressure rhythms and cardiovascular outcome in diabetic and nondiabetic patients with ischemic stroke. Methods The 373 ischemic stroke inpatients with large artery atherosclerosis were recruited and followed up at Cerebrovascular Center of Beijing Tiantan Hospital from May 2010 to August 2011. The baseline data were recorded. Ambulatory blood pressure monitoring was performed. The endpoint events included stroke recurrence, vascular events, and cardiovascular death. Results Totally 367 patients were included in the final analysis. The patients were divided into two groups according to the circadian blood pressure pattern: dipper (76 patients) and nondipper group (291 patients). The patients were followed-up for (19.0±5.0) months. The patients in nondipper group showed a higher prevalence of cardiovascular events, higher nocturnal blood pressure (P<0.05). Kaplan-Meier analysis showed that the cardiovascular events-free survival was lower in nondipper group than those in dipper group but did not reach statistical significance (P=0.052). Kaplan-Meier analysis showed that there were no significant differences in cardiovascular events-free survival between dipper and nondipper groups in nondiabetic patients (P=0.763); However, diabetic patients with nondipper showed a less cardiovascular events-free survival (P=0.030). Through Cox regression we found that the age (hazard ratio=1.037, 95%CI: 1.008-1.067, P=0.013), diabetes mellitus (hazard ratio=2.406, 95%CI: 1.340-4.319, P=0.003), modified. Rankin Scale (mRS) on admission (hazard ratio=1.379, 95%CI: 1.143-1.664, P=0.001) and nondipper (hazard ratio=0.964, 95%CI: 0.928-1.001, P=0.056) were associated with cardiovascular outcomes in diabetic patients with stroke. Conclusion Abnormal circadian blood pressure rhythms were associated with cardiovascular outcomes in stroke patients with diabetes, but we did not find a correlation between blood pressure rhythms and cardiovascular outcomes in stroke patients without diabetes.

Key words: stroke, ischemic, diabetes mellitus, circadian blood pressure rhythms, outcome

中图分类号:

R743.3

田俊萍, 王鸿, 王红霞, 赵性泉, 陈步星. 糖尿病和非糖尿病的缺血性卒中患者血压昼夜节律与预后的关系[J]. 首都医科大学学报, 2016, 37(1): 62-69.

Tian Junping, Wang Hong, Wang Hongxia, Zhao Xingquan, Chen Buxing. Relationship between circadian blood pressure rhythms and outcome in diabetic and nondiabetic patients with ischemic stroke[J]. Journal of Capital Medical University, 2016, 37(1): 62-69.

参考文献

[1] Ali K, Leong K M, Houlder S, et al. The relationship between dipping profile in blood pressure and neurologic deficit in early acute ischemic stroke [J]. J Stroke Cerebrovasc Dis, 2011,20(1):10-15.
[2] Phillips R A, Butkevich A, Sheinart K F, et al. Dipping is superior to cusums analysis in assessment of the risk of stroke in a case-control study [J]. Am J Hypertens, 2001,14(7 Pt 1):649-652.
[3] Castilla-Guerra L, Fernández-Moreno Mdel C, Espino-Montoro A, et al. Ambulatory blood pressure monitoring in stroke survivors: do we really control our patients[J]? Eur J Intern Med, 2009,20(8):760-763.
[4] Pandian J D, Wong A A, Lincoln D J, et al. Circadian blood pressure variation after acute stroke [J]. J Clin Neurosci, 2006,13(5):558-562.
[5] Tomii Y, Toyoda K, Suzuki R, et al. Effects of 24-hour blood pressure and heart rate recorded with ambulatory blood pressure monitoring on recovery from acute ischemic stroke [J]. Stroke, 2011,42(12):3511-3517.
[6] Jia Q, Zheng H, Zhao X, et al. Abnormal glucose regulation in patients with acute stroke across China: prevalence and baseline patient characteristics [J]. Stroke, 2012,43(3):650-657.
[7] Jia Q, Zhao X, Wang C, et al. Diabetes and poor outcomes within 6 months after acute ischemic stroke: the China National Stroke Registry [J]. Stroke, 2011, 42(10):2758-2762.
[8] Chen B X, Tian J P, Wang H X, et al. Effect of blood pressure variability on cardiovascular outcome in diabetic and nondiabetic patients with stroke [J]. J Stroke Cerebrovasc Dis, 2014,23(9):2450-2457.
[9] 田俊萍, 王鸿,王红霞,等.合并糖尿病的缺血性脑卒中患者的预后分析 [J].临床内科杂志,2015,32(8):539-541.
[10] Matteucci E, Giampietro O.Circadian rhythm of blood pressure in diabetes mellitus: evidence, mechanisms and implications [J]. Curr Diabetes Rev, 2012,8(5):355-361.
[11] Eguchi K. Blood pressure variability/dipper/non-dipper in hypertension and diabetes [J]. Curr Hypertens Rev, 2014,9(4):257-263.
[12] 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组. 中国急性缺血性脑卒中诊治指南2010 [J]. 中华神经科杂志,2010, 43(2):146-153.
[13] Wang Y, Xu J, Zhao X, et al. Association of hypertension with stroke recurrence depends on ischemic stroke subtype [J]. Stroke, 2013,44(5):1232-1237.
[14] Coull A J, Rothwell P M. Underestimation of the early risk of recurrent stroke: evidence of the need for a standard definition [J]. Stroke, 2004, 35(8): 1925-1929.
[15] Rossignol P, Cridlig J, Lehert P, et al. Visit-to-visit blood pressure variability is a strong predictor of cardiovascular events in hemodialysis: insights from FOSIDIAL [J]. Hypertension, 2012,60(2):339-346.
[16] Anan F, Takahashi N, Ooie T, et al. Role of insulin resistance in nondipper essential hypertensive patients [J]. Hypertens Res, 2003,26(9):669-676.
[17] 尹宁宁,岳晓艳,蔡业华,等. 严格血糖控制对重症脑损伤患者转归的影响——临床荟萃分析[J]. 首都医科大学学报,2013,34(2):181-186.
[18] Lucke-Wold B P, Turner R C, Lucke-Wold A N, et al. Age and the metabolic syndrome as risk factors for ischemic stroke: improving preclinical models of ischemic stroke [J]. Yale J Biol Med, 2012,85(4):523-539.

糖尿病和非糖尿病的缺血性卒中患者血压昼夜节律与预后的关系

Relationship between circadian blood pressure rhythms and outcome in diabetic and nondiabetic patients with ischemic stroke

PDF

可视化

被引次数

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	徐建可, 刘宁, 韩苗, 张洪阳, 韩新生. 缺血性脑卒中患者颈动脉斑块性质与非高密度脂蛋白胆固醇浓度的相关性[J]. 首都医科大学学报, 2023, 44(1): 49-53.
[2]	秦琳慧, 李宁, 杨宇, 杨勇, 任长虹. 肢体远隔缺血期适应联合后适应促进大鼠缺血性脑卒中模型神经发生的作用及机制[J]. 首都医科大学学报, 2023, 44(1): 54-61.
[3]	李雪, 范俊芬, 王荣亮, 马青峰, 罗玉敏, 赵海苹. HDAC2对急性缺血性卒中患者中性粒细胞TBC蛋白家族成员的表观调控[J]. 首都医科大学学报, 2023, 44(1): 62-71.
[4]	姜富城, 黄菊梅, 冯跃先, 钟红亮, 贾建文, 杨洪超, 刘赫, 刘扬. 清醒镇静在急性缺血性脑卒中血管内治疗中的应用效果及预后影响评估[J]. 首都医科大学学报, 2023, 44(1): 72-77.
[5]	李森, 郭学文, 赵鑫, 黄安琪, 林婧格, 李兴茂, 李秀, 杜怡峰, 赵咏梅, 白洁, 夏章勇. 急性缺血性脑卒中合并糖尿病人群的血糖变异性与神经功能恶化的相关性分析[J]. 首都医科大学学报, 2023, 44(1): 78-84.
[6]	苏志燕, 刘薇, 史婷婷. 老年2型糖尿病患者血尿酸浓度与代谢综合征的相关性分析[J]. 首都医科大学学报, 2023, 44(1): 137-142.
[7]	王荣荣, 田俊萍. 急性冠脉综合征患者血清钙与心血管预后的关系[J]. 首都医科大学学报, 2023, 44(1): 154-160.
[8]	贾静, 陈文明, 李燕郴. 多发性骨髓瘤伴中枢侵犯临床特征及预后分析[J]. 首都医科大学学报, 2023, 44(1): 161-166.
[9]	赵继宗. 我国脑心血管共患疾病现状与临床研究[J]. 首都医科大学学报, 2022, 43(5): 671-673.
[10]	黄琪, 周亦伦, 孙雪峰. 共享外周循环对糖尿病肾病小鼠肾损伤的影响[J]. 首都医科大学学报, 2022, 43(5): 674-679.
[11]	王梦迪, 郭弋凡, 庞彦余, 刘羽飞, 赵文景. 保肾通络方含药血清调节线粒体自噬对高糖诱导下足细胞氧化损伤的影响[J]. 首都医科大学学报, 2022, 43(5): 687-693.
[12]	于天宇, 姜世敏, 高红梅, 邹古明, 李文歌. 糖尿病肾病慢性肾脏病4期患者肾脏临床及病理因素与预后的关系[J]. 首都医科大学学报, 2022, 43(5): 707-712.
[13]	郭康林, 程一春, 葛树旺, 徐钢. IgA肾病国际风险预测工具在中国人群中的预测效果评价[J]. 首都医科大学学报, 2022, 43(5): 713-719.
[14]	马艺欣, 张仲迎, 佀思聪, 罗鸿宇, 赵欢, 杨伟. 2型糖尿病患者新型脂肪因子血清内脏脂肪素和内脏脂肪特异性丝氨酸蛋白酶抑制因子的表达水平与左心室肥厚的关系[J]. 首都医科大学学报, 2022, 43(5): 767-773.
[15]	安宇, 边南南, 丁小雨, 常晓娜, 刘佳, 王广. 1型糖尿病伴认知功能损伤小鼠脑组织肠道菌群代谢物的改变[J]. 首都医科大学学报, 2022, 43(4): 622-629.