老年高血压患者不稳定性颈动脉斑块与腔隙性脑梗死、脑白质病变及认知功能障碍的关系研究  

Effect of Carotid Atherosclerosis on Lacunar Infarction,Leukoencephalopathy and Cognition Disorders in Elderly Hypertension Patients

作　　者：苏琳[1] 张庆文[1] 李卫[1] 康丽萍[1] 周全[1] 杨素敏[1] 郭远[1] 张万蕾 

机构地区：[1]北京大学人民医院老年科,北京市100044 [2]超声室

出　　处：《中国全科医学》2014年第16期1855-1858,共4页Chinese General Practice

摘　　要：目的探讨老年高血压患者不稳定性颈动脉斑块与腔隙性脑梗死、脑白质病变及认知功能障碍的关系。方法选择2010年10月—2012年12月在我科住院的老年高血压患者64例,根据颈动脉斑块性质将患者分为稳定性斑块组27例和不稳定性斑块组37例;另选同期在我院体检血压正常且无颈动脉粥样硬化的老年人38例为对照组。检测所有受试者血脂、血压,行颈动脉超声检查、颅脑CT检查,采用改良中文版蒙特利尔认知评估量表(MoCA量表)进行认知功能测定。结果不稳定性斑块组LDL水平高于稳定性斑块组,HDL水平低于稳定性斑块组,收缩压高于对照组(P<0.05)。3组受试者颈总动脉和颈内动脉内膜中层厚度(IMT)比较,差异均无统计学意义(P>0.05)。不稳定性斑块组2型糖尿病、脑白质病变及认知功能障碍发生率高于稳定性斑块组和对照组,腔隙性脑梗死发生率低于稳定性斑块组、高于对照组(P<0.05);稳定性斑块组2型糖尿病、腔隙性脑梗死、脑白质病变及认知功能障碍发生率均高于对照组(P<0.05)。不稳定性斑块组MoCA量表分项视空间与执行能力、延迟回忆得分均较稳定性斑块组和对照组降低(P<0.05)。线性相关分析结果显示,不稳定性斑块检出率与脑白质病变发生率呈正相关(r=0.187,P<0.05),与HDL水平呈负相关(r=-0.536,P=0.033),与腔隙性脑梗死、认知功能障碍发生率均无直线相关性(P>0.05)。结论老年高血压伴颈动脉不稳定性斑块形成患者腔隙性脑梗死、脑白质病变及认知功能障碍发生率增高,血脂异常是导致颈动脉粥样硬化的重要因素,在对老年高血压患者进行治疗时,应配合合理的调脂治疗及膳食干预。Objective To investigate the relationship of carotid atherosclerosis （CA） with lacunar infarction （LI）, leukoencephalopathy （LE） and cognition disorders in elderly hypertension patients. Methods A total of 64 elderly hyperten- sion patients hospitalized in this hospital from October 2010 to December 2012 were divided, according to properties of carotid plaque, into groups A （with stable plaque, n = 27 ） , B （with unstable plaque, n = 37 ） ; another 38 healthy elderly subjects without CA were enrolled as control group. Blood fat, blood pressure were detected, carotid ultrasound and brain CT scan car- ried out, cognitive function determined by Montreal Cognitive Assessment scale （ MoCA scale）. Results LDL level was higher in group B than in group A, HDL lower, SBP higher in group B than in control group （ P 〈 0.05 ）. There was no significant difference in IMT of common carotid artery and internal carotid artery in 3 groups （ P 〉 0. 05 ）. The incidences of T2DM, LE and cognitive function were higher in group B than in groups A, control, and LI incidence lower than in group A, but higher than in control group （P 〈0. 05）. The incidences of T2DM, LI, LE, cognition disorders were higher in group A than in group control （ P 〈 0. 05 ）. The scores of visuospatial, executive ability, delayed recall in MoCA scale were lower in group B than in groups A, control （ P 〈 0. 05 ）. By results of linear correlation analysis, the detection rate of unstable plaque was positively cor- related with incidence of LE （ r = 0. 187, P 〈 0. 05 ）, negatively with HDL level （ r = - 0. 536, P = 0. 033 ）, not linearly cor- related with incidences of LI and cognition disorders （P 〉 0. 05 ）. Conclusion The incidences of LI, LE, cognition disorders are higher in elderly patients with hypertension combined with unstable carotid plaque, and dyslipidemia is an important factor leading to CA. Lipid -lowering therapy and dietary intervention should be given when treating elderly hypert

关 键 词：高血压 颈动脉不稳定性斑块 腔隙性脑梗死 认知障碍 老年人 

分 类 号：R544.11[医药卫生—心血管疾病]