老年人脑微出血与收缩压晨峰的相关性  

Relationship between cerebral microbleeds with morning SBP surge in the elderly

作　　者：张春华 仇发美 赵颖馨 柴强 崔谊[3] 张华 王娟[4] 刘振东 Zhang Chunhua;Qiu Famei;Zhao Yingxin;Chai Qiang;Cui Yi;Zhang Hua;Wang Juan;Liu Zhendong(Shandong First Medical University,Institute of Basic Medicine,Shandong Academy of Medical Sciences,Jinan 250062,Shandong Province,China)

机构地区：[1]山东第一医科大学山东省医学科学院基础医学研究所,济南250062 [2]滨州市人民医院老年科 [3]山东大学齐鲁医院影像科 [4]山东大学第二医院心内科

出　　处：《中华老年心脑血管病杂志》2020年第1期24-27,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家自然科学基金（81500232,81670432,81973139）;山东省重点研发计划项目（2018GSF118044,2017GSF218060,2017GSF18169,2019GSF108079）

摘　　要：目的探讨收缩压晨峰对老年人脑微出血(CMB)的影响。方法 2008年4月~2009年10月于山东省医学科学院心脑血管病防治研究中心选择年龄≥60岁的健康体检的老年人408例。采用24h动态血压监测血压晨峰,根据收缩压晨峰,将受试者分为晨峰组169例[收缩压晨峰≥35mm Hg(1mm Hg=0.133kPa)]和非晨峰组239例(收缩压晨峰<35mm Hg)。分别于2008~2009年(基线)、2010~2012年(随访)和2013~2015年(随访)共进行3次头颅MRI检查评估CMB。患者随访39~72(62.04±6.80)个月,将随访与基线比较,有新发CMB定义为CMB进展。用logistic回归分析影响因素,用Kaplan-Meier生存函数曲线分析,用多元Cox生存回归分析。结果晨峰组诊室收缩压、24h平均收缩压、昼间平均收缩压、昼间平均舒张压、收缩压晨峰、舒张压晨峰和LDL-C水平及CMB患病率显著高于非晨峰组(P<0.05,P<0.01)。logistic回归分析在校正相关混杂因素后,晨峰组患CMB的危险显著高于非晨峰组(OR=2.561,95%CI:1.142~5.743,P=0.019)。晨峰组累积CMB进展率显著高于非晨峰组(18.5%vs 7.6%,χ^2=7.954,Plog-rank=0.005)。在校正包括基线有无CMB在内的相关混杂因素后,晨峰组发生CMB进展的风险显著增高,是非晨峰组的2.353倍(95%CI:1.317~3.197,P=0.002)。结论收缩压晨峰是CMB患病及进展的独立危险因素,过高的收缩压晨峰促进老年人CMB的发展。Objective To study the effect of morning SBP surge on microbleeds(CMB)in the elderly.Methods Four hundred and eight persons aged≥60 years admitted from April 2008 to October 2009 were divided into morning SBP surge(≥35 mm Hg)group(n=169)and non-morning SBP surge(<35 mm Hg)group(n=239).Their 24 morning SBP surge was mornitorted.The patients underwent 3 times of brain magnetic resonance imaging for the assessment of their CMB and were followed up for 39-72(62.04±6.80)months,during which the new CMB were defined as progressive CMB.The influencing factors of morning SBP surge were analyzed by logistic regression analysis,Kaplan-Meier survival function curve analysis and multivariate Cox survival regression analysis respectively.Results The SBP,24 hmean SBP,day mean SBP and DBP,morning SBP and DBP surge,serum LDL-C level and incidence of CMB were significantly higher in morning SBP surge group than in non-morning SBP surge group(P<0.05,P<0.01).The risk of CMB was significantly higher in morning SBP surge group than in non-morning SBP surge group after adjustment for the confounding factors(OR=2.561,95%CI:1.142-5.743,P=0.019).The accumulated progressive rate of CMB was significantly higher in morning SBP surge group than in non-morning SBP surge group(18.5%vs 7.6%,Plog rank=0.005).The risk of progressive CMB was 2.353-fold higher in morning SBP surge group than in non-morning SBP surge group after adjustment for the confounding factors(95%CI:1.317-3.197,P=0.002).Conclusion Morning SBP surge is an independent risk factor for CMB and their progression.High morning SBP surge aggravates the progression of CMB in the elderly.

关 键 词：脑出血 昼夜节律 心电描记术 便携式 

分 类 号：R743.34[医药卫生—神经病学与精神病学]