慢性直立不耐受人群血流动力学模式与缺血性卒中发病风险关系的前瞻性研究

doi:10.13481/j.1671-587X.20240221

Abstract

Abstract:

Objective To discuss the association between hemodynamic patterns and the risk of ischemic stroke in the people with chronic orthostatic intolerance （OI）， and to provide the basis for the early assessment of the onset of ischemic stroke. Methods A total of 638 residents aged ≥40 years from three streets/townships in Changchun City of Jilin Province were selected as the subjects by multistage random sampling method. Transcranial Doppler （TCD） combined with head-up tilt test （HUTT） were used to evaluate the hemodynamic patterns of the people with OI， and the OI research cohort was established. The patients were divided into orthostatic hypotension （OH） group， orthostatic hypertension （OHT） group， postural tachycardia syndrome （POTS） group， and orthostatic cerebral hypoperfusion syndrome （OCHOs） group according to the changes of hemodynamics. The subjects were followed up once every six months for two years， and the first incidence of ischemic stroke of the subjects was regarded as the observation endpoint；the baseline data and incidence of ischemic stroke of the subjects during the follow-up period were collected； Cox proportional hazards model was used to analyze the association factors with the risk of ischemic stroke. Results A total of 121 subjects were diagnosed with OI， including 80 subjects （66.12%） in OH group， 35 subjects （28.93%） in OHT group， 5 （4.13%） subjects in POTS group， and 1 subject （0.82%） in OCHOs group. During the follow-up period， the overall people had 43 confirmed new cases of ischemic stroke. After controlling the related confounding factors， compared with non-OI individuals， the risk of ischemic stroke in the entire OI people， as well as in the OH and OHT patients， was increased by 1.527 times ［hazard ratio （HR）=2.527， 95% confidence interval （CI）： 1.269－5.032， P<0.01）］， 2.268 times （HR=3.268， 95% CI： 1.603－6.663， P=0.001）， and 2.153 times （HR=3.153， 95% CI： 1.213－8.916， P=0.008）， respectively. Conclusion OI is associated with the increased risk of ischemic stroke， particularly in the patients in OH and OHT groups.

Key words: Orthostatic intolerance, Orthostatic hypotension, Orthostatic hypertension, Ischemic stroke, Transcranial doppler, Head-up tilt test

CLC Number:

R743.3

Guanfei LI,Xunjuan ZHANG,Meng PANG,Song LI. Prospective study on association between hemodynamic patterns and risk of ischemic stroke in people with chronic orthostatic intolerance[J].Journal of Jilin University(Medicine Edition), 2024, 50(2): 473-480.

Figures/Tables 5

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Fig. 1

Tab. 2

Tab.3

Tab.4

References 25

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Item	OI group（n=121）	Non-OI group（n=526）	χ²/t	P
Male [n（%）]	68（56.2）	288（54.8）	0.830	0.773
Age （years,x±s）	63.1±11.1	62.1±9.6	0.918	0.360
BMI （kg·m^－2,x±s）	23.5±2.7	23.7±2.6	0.761	0.447
Supine SBP (mmHg,x±s）	136.6±21.8	134.9±18.4	0.776	0.439
Supine DBP (mmHg,x±s）	81.1±12.4	80.2±10.6	0.766	0.445
Supine heart rate (beat·min^－1,x±s)	75.7±13.4	74.8±10.9	0.729	0.466
Current smoking [n（η/%）]	23（19.0）	119（16.0）	0.363	0.547
Heavy alcohol drinking [n（η/%）]	11（9.0）	30（5.7）	1.902	0.168
Physical inactivity [n（η/%）]	37（30.8）	107（20.3）	5.957	0.015
Hypertension [n（η/%）]	43（35.5）	118（22.4）	9.037	0.004
Diabetes [n（η/%）]	24（19.8）	84（16.0）	1.057	0.343
Coronary heart disease [n（η/%）]	5（4.1）	18（3.4）	0.145	0.784
Dyslipidemia [n（η/%）]	29（24.0）	95（18.1）	2.215	0.158
Antihypertensive medication [n（η/%）]	18（14.9）	58（11.0）	1.718	0.205

Variable	Assignment
Gender	Female=0， Male=1
Age（year）	40－49=0，50－59=1，60－69= 2，70 years old and above=3
BMI（kg·m^－2）	18.5－23.9=0，24.0－27.9= 1，28.0 and above=2
CBFv decline	No=0，Yes=1
Current smoking	No=0，Yes=1
Heavy alcohol drinking	No=0，Yes=1
Physical inactivity	No=0，Yes=1
Hypertension	No=0，Yes=1
Diabetes	No=0，Yes=1
Coronary heart disease	No=0，Yes=1
Dyslipidemia	No=0，Yes=1

Variable	β	SE	Wald χ²	P	HR （95%CI）
Gender
Female					1.000
Male	1.098	0.359	9.430	0.002	3.008(1.489－6.073)
Age（year）
40－					1.000
50－	0.390	0.494	0.006	0.937	1.039(0.395－2.735)
60－	0.310	0.410	0.574	0.449	1.364(0.328－3.636)
70－	0.271	0.364	0.553	0.457	1.311(0.374－3.557)
BMI（kg·m^－2）
18.5－					1.000
24.0－	0.273	0.539	0.257	0.612	1.314(0.457－3.776)
28.0 and above	0.356	0.320	1.236	0.266	1.427(0.762－2.673)
CBFv decline
No					1.000
Yes	2.124	0.598	12.618	0.000	8.361（2.591－26.987）
Current smoking
No					1.000
Yes	0.052	0.359	0.021	0.884	1.054(0.522－2.128)
Heavy alcohol drinking
No					1.000
Yes	1.016	0.411	6.099	0.014	2.761(1.233－6.184)
Physical inactivity
No					1.000
Yes	0.382	0.387	0.973	0.324	1.465(0.686－3.130)
Hypertension
No					1.000
Yes	0.841	0.302	7.767	0.005	2.319(1.284－4.190)
Diabetes
No					1.000
Yes	0.077	0.390	0.039	0.844	1.080(0.503－2.318)
Coronary heart disease
No					1.000
Yes	0.315	0.723	0.189	0.664	1.730（0.332－5.654)
Dyslipidemia
No					1.000
Yes	0.888	0.524	2.872	0.090	2.429(0.870－6.783)

Group	n	Model 1		Model 2		Model 3
Group	n	HR（95% CI）	P	HR（95% CI）	P	HR（95% CI）	P
Non-OI	526	1.000		1.000		1.000
OI	121	3.468（1.910－6.299）	<0.01	3.157（2.005－6.621）	<0.01	2.527（1.269－5.032）	<0.01
OH	80	3.677（1.858－7.279）	<0.01	3.348（1.696－6.610）	<0.01	3.268（1.603－6.663）	0.001
OHT	35	3.879（1.601－9.397）	0.003	3.722（1.535－9.022）	0.004	3.153（1.213－8.916）	0.008

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Prospective study on association between hemodynamic patterns and risk of ischemic stroke in people with chronic orthostatic intolerance

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