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

摘要： 背景　血清同型半胱氨酸（Hcy）可参与多种细胞的甲基化过程，高Hcy血症可增加脑卒中的发生风险，而高血压是脑卒中最重要的危险因素，目前关于H型高血压对急性脑梗死分型及近期预后的影响的报道较少。目的　探讨H型高血压与急性脑梗死牛津郡社区卒中项目（OCSP）分型及患者近期预后的关系。方法　2016年2月—2018年2月，选取海南医学院第一附属医院神经内科临床诊断急性脑梗死住院患者226例，根据其是否患有原发性高血压及血清Hcy水平分为四组：单纯脑梗死组（n=41）、单纯高Hcy组（n=70）、单纯高血压组（n=42）、H型高血压组（n=73）。对比各组患者的脑梗死OCSP分型及临床特征，并采用美国国立卫生研究院卒中量表（NIHSS）、日常生活活动能力Barthel指数（BI）计分法及改良Rankin量表（mRS），对比分析各组患者入院时及发病30 d后的神经功能缺损与预后情况。结果　不同组别患者的脑梗死类型构成不同（P<0.01）。各组患者入院时NIHSS评分、发病30 d后BI评分和mRS评分比较，差异有统计学意义（P<0.01）；H型高血压组入院时NIHSS评分高于单纯高血压组（P<0.05），发病30 d后BI评分低于单纯脑梗死组、单纯高Hcy组、单纯高血压组，mRS评分高于单纯脑梗死组、单纯高血压组（P<0.05）。H型高血压组不同OCSP分型患者入院时NIHSS评分及发病30 d后BI评分、mRS评分比较，差异有统计学意义（P<0.05）；完全前循环梗死（TACI）组入院时NIHSS评分高于腔隙性梗死（LACI）组、后循环梗死（POCI）组及部分前循环梗死（PACI）组（P<0.05），与LACI组比较，PACI及TACI组发病30 d后BI评分更低（P<0.05）、mRS评分更高（P<0.05）。Logistic回归分析显示，H型高血压、TACI型脑梗死、PACI型脑梗死、POCI型脑梗死是急性脑梗死发病30 d预后差的危险因素（P<0.05）。结论　H型高血压可能是急性脑梗死患者病情加重及预后不良的重要因素之一。临床上，H型高血压患者发生急性脑梗死后，以LACI型最为多见，其30 d预后相对较好，但若为TACI型，则30 d预后较差，应格外注意其病情进展情况。因此，早期识别、早期积极干预H型高血压，将对有效防控急性脑梗死、改善残疾程度具有重要意义。

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