目的 探讨慢性直立不耐受（OI）人群血流动力学模式与缺血性卒中发病风险的关联，为早期评估缺血性卒中的发病提供依据。 方法 以多阶段随机抽样的方法抽取吉林省长春市3个街道/乡镇≥40岁638名居民作为研究对象，经颅多普勒（TCD）联合直立倾斜试验（HUTT）评估OI人群血流动力学模式，建立OI研究队列；按血流动力学改变模式将患者分为直立位低血压（OH）组、直立位高血压（OHT）组、体位性心动过速综合征（POTS）组和直立性脑低灌注综合征（OCHOs）组；对入选的研究对象每半年随访1次，随访2年；以首次缺血性卒中发病为观察终点，收集研究对象基线资料和随访期间缺血性卒中发病情况，采用Cox比例风险模型分析与缺血性卒中发病风险关联的因素。 结果 121例研究对象符合OI诊断标准，其中OH组 80例（66.12%），OHT组 35例（28.93%），POTS 组5例（4.13%），OCHOs组 1例（0.82%）；随访期间，总体人群确诊新发缺血性脑卒中事件共43例；在控制相关混杂因素后，以非OI者为参照，OI全人群、OH和OHT患者发生缺血性卒中的风险分别增加1.527倍［风险比（HR）=2.527，95%CI：1.269~5.032，P<0.01］、2.268倍（HR=3.268，95%CI：1.603~6.663，P=0.001）和2.153倍（HR=3.153，95%CI：1.213~8.916，P=0.008）。 结论 OI与缺血性卒中发病风险增加有关，其中OH组和OHT组患者发病风险增加尤为明显。

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.