原发性高血压患者24小时动态血压变异性与脑白质病变的相关性研究  

Clinical study of the relationship between blood pressure variability and white matter lesions in patients with essential hypertension

作　　者：潘杰[1] 韩宁 李华[1] 钟萍[3] 岳丹丹[1] 陈昕[1] 魏珍玉[1] 吴丹红[1] 

机构地区：[1]上海交通大学医学院附属第三人民医院神经内科,201900 [2]上海长海医院脑血管病中心 [3]上海市中西医结合医院脑病科

出　　处：《临床内科杂志》2015年第12期807-810,共4页Journal of Clinical Internal Medicine

基　　金：上海市科委科研基金资助项目（14411972000）;上海市卫生与计划生育委员会科研基金资助项目（201440332）;上海交通大学医学院科研基金项目（13XJ22010）

摘　　要：目的探讨原发性高血压患者24小时动态血压变异性（BPV）与脑白质病变（WMLs）的关系。方法入选原发性高血压患者182例，均行头颅核磁共振（MRI）检查和动态血压监测（ABPM）。依据国际Fazekas量表评分分为两组：元-轻度WMLs组110例，中-重度WMLs组72例。分析24小时动态血压监测各时段的血压平均值、标准差和变异系数。结果中-重度WMLs组年龄明显高于无-轻度WMLs组（P〈0．01），无-轻度组高密度脂蛋白胆固醇明显高于中-重度WMLs组，中-重度WMLs组的24小时平均动脉压（24hMAP）、白天平均收缩压（dmSBP）、夜间平均收缩压（nmSBP）、24小时平均动脉压标准差（24hMAPSD）、白天收缩压标准差（dSBPSD）、白天舒张压标准差（dDBPSD）、白天收缩压变异系数（dSBPCV）及白天舒张压变异系数（dDBPCV）的均值均高于无-轻度WMLs组，差异均有统计学意义（P均〈0．05），经二元Logistic回归分析表明，年龄、dSBPSD与中-重度WMLs独立相关（OR分别为1．06，1．191；P均〈0．05）。结论年龄、dSBPSD与WMLs的严重程度关系密切，对WMLs的发生和严重程度有较好的预测作用。Objective To investigate the relationship between blood pressure variability and white matter lesions in patients with essential hypertension. Methods 182 patients with primary hypertension were recriuted. All patients were examined cerebral MRI and 24 h ambulatory blood pressur monitoring （ABPM）. Patients were subdivided into mild WMLs, moderate WMLs and severe WMLs according to Fazekas rating scale based on the number of cerebral white matter lesions. The three grades were divided into two categories：non and mild WMLs group（n = 110） ,moderate and severe WMLs group （n = 72）. Analyze the mean blood pressures （systolic blood pressures and diastolic blood pressures）and the blood pressure variability [ the standard deviations （SD） and coefficient variation （ CV ） ] of 24hABPM. Results The average age in the group of moderate and severe WMLs was higher than that in the group of non and mild WMLs, and the difference was significant（P 〈 0.01 ）. The high density lipoprotein cholesterol （HDL-C） in the group of moderate and severe WMLs was lower than that in the group of non and mild WMLs, the 24hMAP, dmSBP, nmSBP,24hMAPSD, dSBPSD, dDBPSD, dSBPCV and dDBPCV of moderate and severe WMLs group were higher than that in the group of non and mild WMLs （ P 〈 0.05 ）. The age and dSBPSD are independently relevant to moderate and severe WMLs （OR：1. 06 vs 1. 191 ;P 〈 0.05 ）. Conclusion The dSBPSD and age are closely associated with the severity of WMLs, which are good predictors of WMLs occurrance and severity.

关 键 词：血压变异性 脑白质病变 原发性高血压 脑小血管病 

分 类 号：R544.1[医药卫生—心血管疾病]