论文部分内容阅读
目的探讨高同型半胱氨酸血症的高血压(H型高血压)与高血压脑出血早期血肿扩大及3个月时临床转归和死亡的关系。方法纳入2013年1月至2014年12月本科住院的高血压原发性脑出血患者298例,记录其一般资料,在起病6h内及24h行CT扫描,同时检测同型半胱氨酸(Hcy)、血糖、胆固醇、纤维蛋白原等及美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分。随访3个月,记录改良Bathel(MBI)量评分及死亡例数。结果血浆Hcy水平升高[优势比(odds ratio,OR)=0.356,95%可信区间(confidence interval,CI):0.131~0.826;P=0.021]和收缩压增高(OR=1.021,95%CI:1.002~1.028;P=0.045)是原发性脑出血患者血肿扩大的独立危险因素。血浆Hcy升高(OR=1.031,95%CI:1.021~1.278;P=0.035)和收缩压增高(OR=1.141,95%CI:1.011~1.072;P=0.034)是临床转归不良的独立危险因素。收缩压增高(OR=1.023,95%CI:1.007~1.051;P=0.021)、血糖高(OR=1.382,95%CI:1.221~1.673;P=0.004)、Hcy水平增高(OR=1.521,95%CI:1.025~8.096;P=0.023)是3个月内死亡的独立危险因素。结论 H型高血压是原发性脑出血早期血肿扩大及3个月时临床转归和死亡的独立预测因素。
Objective To investigate the relationship between hypertensive hyperhomocysteinemia (Hypertension) and early hypertensive intracerebral hemorrhage (HH) hematoma enlargement and clinical outcome and death at 3 months. Methods A total of 298 hypertensive patients with primary cerebral hemorrhage admitted to our hospital from January 2013 to December 2014 were enrolled in this study. General information was recorded. CT scans were made within 6 hours and 24 hours of onset, meanwhile homocysteine (Hcy ), Blood glucose, cholesterol, fibrinogen and the National Institutes of Health Stroke Scale (NIHSS) score. The patients were followed up for 3 months. The modified Bathel score and the number of deaths were recorded. Results The plasma homocysteine level increased (OR = 0.356, 95% confidence interval (CI): 0.131-0.826; P = 0.021] and systolic blood pressure increased (OR = 1.021, 95% CI : 1.002 ~ 1.028; P = 0.045) was an independent risk factor for hematoma enlargement in patients with primary cerebral hemorrhage. Elevated plasma Hcy (OR = 1.031, 95% CI: 1.021-1.278; P = 0.035) and increased systolic blood pressure (OR = 1.141, 95% CI: 1.011 to 1.072; P = 0.034) were independent risk for poor clinical outcome factor. Systolic blood pressure (OR = 1.023, 95% CI: 1.007-1.051; P = 0.021), high blood sugar (OR = 1.382, 95% CI: 1.221-1.673; % CI: 1.025 ~ 8.096; P = 0.023) were independent risk factors for death within 3 months. Conclusions Hypertension is an independent predictor of early hematoma expansion in primary ICH and clinical outcomes and death at 3 months.