关键词: 高血压, 脑梗死, H型高血压, 牛津郡社区卒中项目（OCSP）, 预后

Abstract: Background　Serum homocysteine（Hcy）may involve in the methylation of many kinds of cells.Hyperhomocysteinemia can increase the risk of stroke，while hypertension is the most important risk factor for stroke.However，there are few reports on the influence of H-type hypertension on the classification and short-term outcome of acute cerebral infarction（ACI）．Objective　To analyze the relationship of H-type hypertension with Oxfordshire Community Stroke Project（OCSP）classification and short-term outcome of ACI.Methods　226 patients clinically diagnosed with ACI in Department of Neurology，the First Affiliated Hospital of Hainan Medical University were enrolled from February 2016 to February 2018，and were divided into four groups according to the prevalence of primary hypertension and serum Hcy level：simple ACI group（n=41），simple high Hcy group（n=70），simple hypertension group（n=42），and H-type hypertension group（n=73）.Intergroup comparisons were performed in terms of OCSP classification and clinical characteristics of ACI，neurological status assessed by the National Institutes of Health Stroke Scale（NIHSS），and outcomes assessed by Barthel Index（BI）and modified Rankin Scale（mRS）at admission and on the 30th day after the onset of ACI.Results　The percentages of four subtypes of ACI assessed by OCSP classification differed significantly across the four groups（P<0.01）．Mean NIHSS score，BI and mRS score at admission and at the 30th day after onset of ACI also varied obviously across the four groups（P<0.01）．To be specific，H-type hypertension group showed higher mean NIHSS score at admission compared with simple hypertension group（P<0.05），lower BI on the 30th day after ACI onset compared with other three groups（P<0.05），and higher mRS score on the 30th day after ACI onset compared with simple ACI and simple hypertension groups（P<0.05）．In H-type hypertension group，lacunar infarction（LACI），posterior circulation infarction（POCI），partial anterior circulation infarction（PACI），and total anterior circulation infarction（TACI）patients showed significantly different mean NIHSS score，BI and mRS score at admission and at the 30th day after ACI onset（P<0.05）．TACI patients demonstrated higher mean NIHSS score at admission compared with other three subgroups（P<0.05）．LACI patients showed higher mean BI and lower mean mRS score at the 30th day after ACI onset compared with PACI and TACI subgroups（P<0.05）．Logistic regression analysis revealed that H-type hypertension，TACI，PACI and POCI were risk factors for poor outcome within 30 days after ACI onset（P<0.05）．Conclusion　H-type hypertension may be an important factor associated with the aggravation of the conditions and deterioration of the short-term outcome of ACI.In H-type hypertension patients with ACI，the most common subtype is LACI，with a relatively good outcome within 30 days after ACI onset，but TACI may has a relatively poor outcome.So the progression of ACI should be paid special attention.Early identification of H-type hypertension and delivering active interventions timely，are important actions to effectively prevent and control ACI，and reduce the level of stroke-induced disability.

Key words: Hypertension, Brain infarction, H-type hypertension, Oxfordshire Community Stroke Project（OCSP）, Prognosis