血压水平与高血压脑卒中发病风险的关系研究

doi:10.3877/cma.j.issn.2095-9141.2015.05.002

目的

探讨血压与其他危险因素并存时对于高血压脑卒中患病率的影响，从而有效预防处于危险状态人群卒中的初发以及卒中幸存者的卒中再发。

方法

选择自2014年5月至2015年5月在徐州市中心医院心内科住院治疗2 396例原发性高血压患者的病例资料，包括年龄、性别、体质指数(BMI)、血压、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、空腹血糖(GLU)、同型半胱氨酸(Hcy)以及疾病既往史等，采用Logistic回归模型，引入交叉乘积项分析血压与其他危险因素对于原发性高血压脑卒中患病率的影响。

结果

2 396例原发性高血压患者中，与血压达标者相比，未达标者空腹GLU的水平显著升高[(6.13±1.91) mmol/L对比(6.45±2.24) mmol/L，t=2.652，P=0.003]，而HDL-C的含量显著降低[(39.27±11.97) mmol/L对比(36.28±11.45) mmol/L，t=4.702，P=0.000]，合并糖尿病、脑卒中及高同型半胱氨酸血症的比例明显增加(χ²分别为4.910，140.630，44.284，P<0.05)。在年龄45~74岁以及BMI、空腹GLU、非HDL-C、TG、Log Hcy的不同分层中，高血压患者随着血压水平的升高，脑卒中的患病率逐渐增加(P<0.05)。

结论

血压与Hcy的交互作用能够增加高血压患者脑卒中的患病率。对于高血压合并脑卒中患者，年龄与性别对非HDL-C、TG水平的影响存在交互。

关键词: 血压, 脑卒中, 同型半胱氨酸, 血脂障碍

Objective

To analyze both blood pressure and other risk factors associated with the prevalence of stroke in hypertension patients for the prevention of an initial stroke and future stroke among survivors of stroke.

Methods

Detailed information of 2 396 patients with essential hypertension were collected including age, gender, body mass index (BMI), blood pressure (BP), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG), fasting glucose (GLU), homocysteine (Hcy), and past history of diabetes mellitus, hyperlipemia, stroke and hyperhomocysteinemia. The detectable interaction between BP and stratified factors is examined by adding the BP × stratified factors cross-product to a logistic regression analysis of the hypertension participants.

Results

A total of 2 396 patients with primary hypertension were enrolled in this study. Hypertension patients with BP≥140/90 mmHg had a significantly higher fasting GLU(6.13±1.91 vs. 6.45±2.24, t=2.652, P=0.003), lower HDL-C level (39.27±11.97 vs. 36.28±11.45, t=4.702, P=0.000) than that of patients with BP<140/90 mmHg, as was also their exposure to diabetes mellitus, stroke and hyperhomocysteinemia (χ²=4.910, 140.630, 44.284, respectively, P<0.05). An increasing level of blood pressure was associated with higher stroke risk the condition of age range 45-74, and full scope of BMI, fasting GLU, non-HDL-C, TG and Log Hcy(P<0.05).

Conclusions

Among the hypertension participants, significant interaction on stroke risk was observed between blood pressure and Log Hcy. Age and gender interacted with non-HDL-C and TG in hypertension patients with stroke.

Key words: Blood pressure, Stroke, Homocysteine, Dyslipidemia

表1 原发性高血压患者降压治疗达标者与未达标者的基本情况比较

变量		降压达标(n=394)	降压未达标(n=2002)	t/χ²值	P值
年龄(岁)		60.9±8.0	60.7±8.9	0.456	0.624
男[n(%)]		250(63.45)	1224(61.14)	0.649	0.388
BMI (kg/m²)		24.73±3.45	24.65±3.48	0.418	0.667
吸烟[n(%)]		185(46.95)	889(44.41)	0.765	0.352
饮酒[n(%)]		146(37.06)	738(36.86)	0.000	0.942
SBP (mmHg)		124.94±9.84	161.31±21.75	32.539	0.000
DBP (mmHg)		77.45±7.06	94.93±13.05	26.037	0.000
空腹GLU (mmol/L)		6.13±1.91	6.45±2.24	2.652	0.003
TC (mmol/L)		4.95±0.95	4.87±1.03	1.498	0.134
HDL?C (mmol/L)		1.01±0.31	0.94±0.30	4.702	0.000
非HDL?C (mmol/L)		3.94±0.91	3.93±0.98	0.125	0.894
TG (mmol/L)		1.80±0.93	1.85±0.98	0.874	0.383
Hcy (μmol/L)		17.33±14.85	18.02±13.38	0.918	0.356
基础疾病[n(%)]		?	?	?	?
?	糖尿病	84(21.32)	537(26.82)	4.910	0.023
?	高脂血症	199(50.51)	954(47.65)	0.964	0.300
?	脑卒中	166(42.13)	1 458(72.83)	140.630	0.000
?	高Hcy血症	169(42.89)	1 224(61.14)	44.284	0.000

表1 原发性高血压患者降压治疗达标者与未达标者的基本情况比较

变量		降压达标(n=394)	降压未达标(n=2002)	t/χ²值	P值
年龄(岁)		60.9±8.0	60.7±8.9	0.456	0.624
男[n(%)]		250(63.45)	1224(61.14)	0.649	0.388
BMI (kg/m²)		24.73±3.45	24.65±3.48	0.418	0.667
吸烟[n(%)]		185(46.95)	889(44.41)	0.765	0.352
饮酒[n(%)]		146(37.06)	738(36.86)	0.000	0.942
SBP (mmHg)		124.94±9.84	161.31±21.75	32.539	0.000
DBP (mmHg)		77.45±7.06	94.93±13.05	26.037	0.000
空腹GLU (mmol/L)		6.13±1.91	6.45±2.24	2.652	0.003
TC (mmol/L)		4.95±0.95	4.87±1.03	1.498	0.134
HDL?C (mmol/L)		1.01±0.31	0.94±0.30	4.702	0.000
非HDL?C (mmol/L)		3.94±0.91	3.93±0.98	0.125	0.894
TG (mmol/L)		1.80±0.93	1.85±0.98	0.874	0.383
Hcy (μmol/L)		17.33±14.85	18.02±13.38	0.918	0.356
基础疾病[n(%)]		?	?	?	?
?	糖尿病	84(21.32)	537(26.82)	4.910	0.023
?	高脂血症	199(50.51)	954(47.65)	0.964	0.300
?	脑卒中	166(42.13)	1 458(72.83)	140.630	0.000
?	高Hcy血症	169(42.89)	1 224(61.14)	44.284	0.000

表2 血压对于原发性高血压脑卒中患病率的影响[OR(95% CI)]

变量		血压(mmHg)				P值(趋势分析)	P值(交互作用)
变量		<140/90(n=394)	140～159/90～99(n=827)	160～179/100～109(n=597)	≥180/110(n=578)	P值(趋势分析)	P值(交互作用)
年龄(岁)		?	?	?	?	?	0.341
?	≤44(n=101)	1	/	/	/	0.206	?
?	45～59(n=860)	1	1.584(1.010～2.485)	6.501(3.834～11.024)	34.103(16.798～69.233)	0.000	?
?	60～74(n=1352)	1	1.597(1.122～2.272)	5.344(3.584～7.968)	25.839(14.448～46.213)	0.000	?
?	≥75(n=83)	1	/	/	/	0.076	?
BMI(kg/m²)		?	?	?	?	?	0.318
?	<24(n=1034)	1	1.608(1.064～2.430)	7.965(4.853～13.075)	33.870(16.160～70.987)	0.000	?
?	24～27.9(n=992)	1	1.518(1.026～2.247)	4.911(3.110～7.756)	25.970(13.014～51.825)	0.000	?
?	≥28(n=370)	1	0.866(0.447～1.678)	2.824(1.380～5.778)	15.564(6.484～37.358)	0.000	?
空腹GLU(mmol/L)		?	?	?	?	?	0.109
?	<6.1(n=1475)	1	1.188(0.863～1.635)	4.178(2.906～6.007)	30.490(16.535～56.225)	0.000	?
?	6.1～6.9(n=409)	1	2.625(1.335～5.164)	9.919(4.599～21.394)	32.884(12.908～83.775)	0.000	?
?	≥7.0(n=512)	1	1.502(0.829～2.721)	10.209(4.271～24.402)	13.540(5.862～31.276)	0.000	?
非HDL～C(mmol/L)		?	?	?	?	?	0.646
?	<160(n=1437)	1	1.288(0.922～1.799)	4.915(3.287～7.350)	28.213(15.045～52.903)	0.000	?
?	160～189(n=611)	1	2.374(1.390～4.054)	7.739(4.275～14.008)	42.952(18.326～100.671)	0.000	?
?	≥190(n=348)	1	0.826(0.376～1.815)	3.816(1.609～9.048)	12.649(4.627～34.581)	0.000	?
TG(mmol/L)		?	?	?	?	?	0.543
?	<150(n=1288)	1	1.423(0.991～2.045)	5.479(3.596～8.348)	27.952(15.500～50.410)	0.000	?
?	150～199(n=485)	1	1.748(0.958～3.187)	10.471(5.115～21.437)	19.606(8.272～46.470)	0.000	?
?	≥200(n=623)	1	1.315(0.793～2.180)	3.597(2.015～6.423)	59.113(17.201～203.144)	0.000	?
Log Hcy		?	?	?	?	?	0.000
?	<1.09(n=783)	1	1.305(0.814～2.092)	3.935(2.323～6.668)	18.520(9.412～36.441)	0.000	?
?	1.09～1.23(n=862)	1	1.438(0.936～2.210)	6.031(3.661～9.935)	28.930(14.040～59.609)	0.000	?
?	>1.23(n=751)	1	1.397(0.877～2.225)	6.551(3.644～11.780)	44.399(15.285～128.964)	0.000	?

表2 血压对于原发性高血压脑卒中患病率的影响[OR(95% CI)]

变量		血压(mmHg)				P值(趋势分析)	P值(交互作用)
变量		<140/90(n=394)	140～159/90～99(n=827)	160～179/100～109(n=597)	≥180/110(n=578)	P值(趋势分析)	P值(交互作用)
年龄(岁)		?	?	?	?	?	0.341
?	≤44(n=101)	1	/	/	/	0.206	?
?	45～59(n=860)	1	1.584(1.010～2.485)	6.501(3.834～11.024)	34.103(16.798～69.233)	0.000	?
?	60～74(n=1352)	1	1.597(1.122～2.272)	5.344(3.584～7.968)	25.839(14.448～46.213)	0.000	?
?	≥75(n=83)	1	/	/	/	0.076	?
BMI(kg/m²)		?	?	?	?	?	0.318
?	<24(n=1034)	1	1.608(1.064～2.430)	7.965(4.853～13.075)	33.870(16.160～70.987)	0.000	?
?	24～27.9(n=992)	1	1.518(1.026～2.247)	4.911(3.110～7.756)	25.970(13.014～51.825)	0.000	?
?	≥28(n=370)	1	0.866(0.447～1.678)	2.824(1.380～5.778)	15.564(6.484～37.358)	0.000	?
空腹GLU(mmol/L)		?	?	?	?	?	0.109
?	<6.1(n=1475)	1	1.188(0.863～1.635)	4.178(2.906～6.007)	30.490(16.535～56.225)	0.000	?
?	6.1～6.9(n=409)	1	2.625(1.335～5.164)	9.919(4.599～21.394)	32.884(12.908～83.775)	0.000	?
?	≥7.0(n=512)	1	1.502(0.829～2.721)	10.209(4.271～24.402)	13.540(5.862～31.276)	0.000	?
非HDL～C(mmol/L)		?	?	?	?	?	0.646
?	<160(n=1437)	1	1.288(0.922～1.799)	4.915(3.287～7.350)	28.213(15.045～52.903)	0.000	?
?	160～189(n=611)	1	2.374(1.390～4.054)	7.739(4.275～14.008)	42.952(18.326～100.671)	0.000	?
?	≥190(n=348)	1	0.826(0.376～1.815)	3.816(1.609～9.048)	12.649(4.627～34.581)	0.000	?
TG(mmol/L)		?	?	?	?	?	0.543
?	<150(n=1288)	1	1.423(0.991～2.045)	5.479(3.596～8.348)	27.952(15.500～50.410)	0.000	?
?	150～199(n=485)	1	1.748(0.958～3.187)	10.471(5.115～21.437)	19.606(8.272～46.470)	0.000	?
?	≥200(n=623)	1	1.315(0.793～2.180)	3.597(2.015～6.423)	59.113(17.201～203.144)	0.000	?
Log Hcy		?	?	?	?	?	0.000
?	<1.09(n=783)	1	1.305(0.814～2.092)	3.935(2.323～6.668)	18.520(9.412～36.441)	0.000	?
?	1.09～1.23(n=862)	1	1.438(0.936～2.210)	6.031(3.661～9.935)	28.930(14.040～59.609)	0.000	?
?	>1.23(n=751)	1	1.397(0.877～2.225)	6.551(3.644～11.780)	44.399(15.285～128.964)	0.000	?

图1 Log Hcy和血压对于高血压脑卒中患病率的交互作用

图2 年龄和性别对于高血压脑卒中患者非HDL-C水平的影响

图3 年龄和性别对于高血压脑卒中患者TG水平的影响

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Levels of blood pressure are associated with the prevalence of stroke in hypertension patients

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Levels of blood pressure are associated with the prevalence of stroke in hypertension patients