Stroke:急性脑出血的收缩压变化轨迹与患者结局

2022-04-12 MedSci原创 MedSci原创

使用基于组的轨迹建模方法进行数据观察可能有助于阐明抗高血压治疗、SBP变化趋势和急性脑出血结局之间的关系。

近日,心血管疾病领域权威杂志Stroke上发表了一篇研究文章,研究人员旨在突出ATACH-2试验(急性脑出血的抗高血压治疗-2)中急性颞动脉血压 (BP) 变化的异质性以及与脑出血结局之间的关联。

从2011年到2015年,对1000名急性脑出血患者进行了分析,这些患者被随机分配到强化(110-139mmHg)或标准(140-179 mmHg)收缩压(SBP)。该研究的结局包括3个月时的死亡或残疾(改良的Rankin量表评分为4-6),24小时内的神经功能恶化(格拉斯哥昏迷量表评分降低≥2分或美国国立卫生研究院中风量表评分增加≥4分),发病后7天内发生急性肾损伤(48小时内≥0.3 mg/dL或血清肌酐升高≥1.5倍)。

基于组的轨迹建模揭示了4个SBP变化轨迹组:中度SBP(从到达医院时的≈190 mmHg到随机化后的150-160 mmHg;n=298),中等到较低SBP(从≈190 mmHg 到<140 mmHg;n=395),从高到低SBP(从>210 mmHg到<140 mmHg;n=134)和高SBP(从>210 mmHg到160-170 mmHg;n=173)。

接受强化治疗的患者分别占各组的11.1%、88.6%、85.1%和1.7%。与中等到较低SBP组相比,高到低SBP组在3个月时的死亡或残疾(调整后比值比为2.29[95%CI为1.24-4.26])和急性肾损伤(调整后的比值比为3.50[95%CI为1.83-6.69])风险增加,而在该组中未观察到神经功能恶化的增加(调整后的比值比为0.48[95%CI为0.20-1.13])。中等SBP和高SBP组在这些结局上没有显著的风险差异。

由此可见,使用基于组的轨迹建模方法进行数据观察可能有助于阐明抗高血压治疗、SBP变化趋势和急性脑出血结局之间的关系。

原始出处:

Kanta Tanaka.et al.Temporal Trajectory of Systolic Blood Pressure and Outcomes in Acute Intracerebral Hemorrhage: ATACH-2 Trial Cohort.stroke.2022.https://www.ahajournals.org/doi/10.1161/STROKEAHA.121.037186

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