2曾进胜-高血压伴糖尿病患者卒中二级预防的关键.pptxVIP

高血压伴糖尿病患者卒中二级预防的关键-----降压达标中山大学附属第一医院神经科曾进胜INTERSTROKE: 高血压是卒中首要危险因素 危险因素人群危险因素对卒中风险占比, % (99% CI)高血压34.6 (30.4–39.1)吸烟18.9 (15.3–23.1)腰臀比 (tertile 3 vs tertile 1)26.5 (18.8–36.0)饮食风险评分 (tertile 3 vs tertile 1)18.8 (11.2–29.7)体力活动28.5 (14.5–48.5)糖尿病5.0 (2.6–9.5)酒精摄入3.8 (0.9–14.4)心源性因素6.7 (4.8–9.1)脂蛋白 B 与 A1比值(tertile 3 vs tertile 1)24.9 (15.7–37.1)精神因素 精神紧张4.6 (2.1–9.6) 抑郁5.2 (2.7–9.8)*For the protective factor of physical activity, the population-attributable risks are provided for individuals who do not participate in regular physical activity.ODonnell MJ et al. Lancet 2010;.高血压与高血糖在卒中发病中起重要作用，卒中后并发率高均可导致脑小动脉病变诱发和加速大动脉粥样硬化对卒中的预后也有重要不良影响giraffe动物实验SHR血压峰值200mmHg，自发脑卒中20%SHRSP血压峰值240-250mmHg，自发脑卒中60-80%遗传因素？？？RHRSP血压峰值200mmHg，自发脑卒中76%；血压峰值200mmHg，自发脑卒中46%Okamota K, et al Circ Res 1974, 34-5(suppl 1);143.Zeng J, et al. Stroke,1998,29:17085相对危险性血压正常组 单纯舒张期高血压组收缩期/舒张期高血压组单纯收缩期高血压组 43据基线血压水平发生中风危险性210血压 IDH SDH ISH正常组血压 IDH SDH ISH正常组高血压患者脑卒中风险是正常血压的3-4倍WomenMenAmerican Journal of Hypertension 1997;10:634The Copenhagen City Heart Study糖尿病患者卒中发生风险是非糖尿病的1.5-3倍The adjusted relative risk (95% confidence interval) of first admission for stroke in women and men with type 2 diabetes mellitus compared with healthy controls. The relative risk was adjusted for tobacco consumption, physical activity alcohol consumption, body mass index, and triglyceride and total cholesterol levels. Almdal T, et al. Arch Intern Med. 2004;164(13):1422-1426.卒中后合并高血压的比例发病48小时82％的卒中患者存在高血压（IST研究）脑灌注急性受损，系统血压升高 －无高血压史的患者：平均血压可达163/90 mmHg －曾经降压治疗的患者：平均血压可达214/118 mmHg应激性血压升高在卒中24h后降低，并在随后的10天自然下降Journal of Hospital Medicine, 2007, 2(4): 261Stroke 2002;33: 1315-20卒中恢复期合并高血糖比例高达70%美国卒中恢复期血糖异常流行病学研究n＝216Ivey FM, et al. Cerebrovasc Dis 2006;22:368–371.无糖尿病史者52%合并高血糖＞45岁，近期出现TIA/缺血性卒中，无糖尿病史，空腹血糖＜7.0mmol/L的患者仍有52%存在高血糖。n=98OGTT检测Kernan WN, Viscoli CM, Inzucchi SE, et al. Arch Intern Med, 2005, 24:227-233.中国南方急性缺血性卒中糖代谢障碍及预后调查Abnormal glucose metabolism associated with acute ischemic stroke in South China