血压变异干预策略对高血压脑白质疏松、预后卒中及认知的影响  

Effect of BPV intervention strategy on hypertensive leukoaraiosis and its prognosis of stroke and cognition

作　　者：方立[1] 袁学谦[1] 张莉峰 尹所 滕军放[3] Li Fang;Xue-qian Yuan;Li-feng Zhang;Suo Yin;Jun-fang Teng(Department of Neurology,Zhengzhou People’s Hospital,Zhengzhou,Henan 450003,China;Department of Radiology,Zhengzhou People’s Hospital,Zhengzhou,Henan 450000,China;Department of Neurology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan 450052,China)

机构地区：[1]郑州人民医院神经内科二病区,河南郑州450003 [2]郑州人民医院影像科,河南郑州450003 [3]郑州大学第一附属医院神经内科,河南郑州450052

出　　处：《中国现代医学杂志》2019年第13期103-108,共6页China Journal of Modern Medicine

摘　　要：目的探讨血压变异性(BPV)干预策略对高血压脑白质疏松(LA)、预后卒中及认知的影响。方法前瞻性研究2013年1月—2016年12月郑州人民医院神经内科就诊并最终纳入统计的高血压患者269例。BPV以血压标准差(SD)、变异系数(CV)表示。其中无或轻度LA组定义为对照组,中重度LA组定义为病变组。采用多因素Logistic回归分析BPV与LA的关系。入院后给予不同类别降压药物,同时,采用简明精神量表(MMSE)进行认知功能状态评分。1年后再次复查患者BPV及LA程度。分析不同降压药物对BPV、LA及1年内卒中事件和认知功能变化的影响。结果①病变组收缩压CV、收缩压SD、杓型分型与对照组比较,差异有统计学意义(P<0.05)。②较高收缩压SD、非杓型特点为LA的危险因素。[O^R=2.168(95%CI:1.120,4.195),P=0.022;O^R=2.764(95%CI:1.405,5.437),P=0.003]。③氨氯地平组用药后中重度LA比例、卒中事件发生率较依那普利及美托洛尔组降低(P<0.05);用药后氨氯地平、依那普利及美托洛尔组的SD分别为(13.756±2.919)、(14.919±3.037)和(15.433±2.962)(P<0.05);用药后氨氯地平、依那普利及美托洛尔组的MMSE评分分别为(27.484±2.267)、(26.575±2.488)和(26.032±3.113)(P<0.05)。结论收缩压SD及非杓型特点是预测LA较好且简易的指标,钙离子拮抗剂或长效降压药物可降低血压变异性,是预防LA、减少卒中及认知功能减退的有效措施。Objective To explore the effect of BPV intervention strategy on hypertensive leukoaraiosis(LA)and its prognosis of stroke and cognition.Methods A prospective study of 269 patients with hypertension from Zhengzhou People's Hospital from January 2013 to December 2016 was included.BPV was expressed as a standard deviation of blood pressure(SD)and a coefficient of variation(CV).Among them,no or mild LA group was defined as the control group,and moderate to severe LA group was defined as the disease group.Multivariate logistic regression was used to analyze the relationship between BPV and LA.Different types of antihypertensive drugs were given after admission,and cognitive function status scores were performed using the Simple Mental Scale(MMSE).After 1 year,the patient's BPV and LA degree were reviewed again.To analyze the effects of different antihypertensive drugs on BPV,LA and stroke and cognitive function changes within 1 year.Results The systolic blood pressure CV,systolic blood pressure SD,and sputum type were significantly different from the control group(P<0.05).Higher systolic blood pressure SD,non-sputum type is a risk factor for LA.[O^R=2.168,(95%CI:1.120,4.195),P=0.022;O^R=2.764,(95%CI:1.405,5.437),P=0.003].The ratio of moderate to severe LA and the incidence of stroke in the amlodipine group were lower than those in the enalapril and metoprolol groups(P<0.05);after administration of amlodipine,enalapril and metoprolol The SD were(13.756±2.919),(14.919±3.037)and(15.433±2.962)(P<0.05).The MMSE scores of amlodipine,enalapril and metoprolol were(27.484±2.267),(26.575±2.488)and(26.032±3.113)(P<0.05).Conclusions Systolic SD and non-sputum type are good and simple indicators for predicting LA.Calcium antagonists or long-acting antihypertensive drugs can reduce blood pressure variability and are effective measures to prevent LA,reduce stroke and cognitive decline.

关 键 词：脑白质疏松症 血压变异性/高血压 降压药/抗高血压药 

分 类 号：R743.34[医药卫生—神经病学与精神病学]