H型高血压和脂蛋白相关磷脂酶A2对脑白质疏松症严重程度及预后的影响  

Effects of H-type hypertension and Lipoprotein-associated phospholipase A2 levelsonseverity and prognosis of leukoaraiosis

作　　者：冯连荣 高光仁 王磊 董爱勤[1] Feng Lianrong;Gao Guangren;Wang Lei;Dong Aiqin(Department of Neurology,the Cangzhou Central Hospital,Hebei 061000,China)

机构地区：[1]沧州市中心医院神经内科,河北061000 [2]沧州市中心医院心内科,河北061000

出　　处：《脑与神经疾病杂志》2021年第1期18-23,共6页Journal of Brain and Nervous Diseases

基　　金：沧州市科技计划项目(162302041)。

摘　　要：目的探讨H型高血压和脂蛋白相关磷脂酶A2(Lp-PLA2)对脑白质疏松症(LA)严重程度及预后的影响.方法前瞻性入选沧州市中心医院2016年3月至2018年3月行头颅CT检查诊断有LA的住院患者,入院后24h内空腹化验血清Lp-PLA2;根据有无高血压和高同型半胱氨酸血症(Hhcy),把LA患者分为:A.同时伴高血压及Hhcy为H型高血压组;B.只有血压升高的为单纯高血压组;C.只有Hcy升高的为单纯Hhcy组;D.血压和Hcy均正常的为对照组.随访2年,以新发脑卒中及全因死亡为研究终点.结果共计入选2204例患者.H型高血压组较对照组中的重度LA患者比例更高(P<0.001),其他组间比较差异无统计学意义(P>0.05);多因素Logistic回归分析显示年龄、糖尿病、吸烟、Lp-PLA2、总胆固醇及H型高血压是影响LA严重程度的独立危险因素;共计2186例患者完成2年临床随访,随访率为99.2%.2年中,H型高血压组新发脑卒中发生率更高(P<0.001).4组间全因死亡差异均无统计学意义(P=0.918).多因素Cox比例风险模型分析显示,年龄、Lp-PLA2、糖尿病、H型高血压是LA患者随访2年新发脑卒中的独立危险因素.而年龄、Lp-PLA2、吸烟史、合并糖尿病H型高血压是LA患者随访2年发生全因死亡的独立危险因素.结论LA患者中,H型高血压及Lp-PLA2不仅是重度LA的独立危险因素,而且是随访2年发生新发脑卒中及全因死亡的独立危险因素.Objective To determine the effects of H-ty pehypertension and lipoprotein-associated phospholipase A2 levels onseverity and prognosis of leukoaraiosis(LA).Methods Patients with LA diagnosed by CT in Cangzhou Central Hospital from Mar.2016 to Mar.2018 were collected.According to the presence or absence of hypertension and hyperhomocysteinemia(Hhcy),patients were divided into the following four groups:A H-hypertension group with hypertension and Hhcy;B simple hypertension group with only hypertension;C simple Hhcy group with only increased Hcy;D control group with normal blood pressure and Hcy.At 2 years follow up,primary endpoints were new stroke(ischemic and hemorrhagic stroke)and all-cause death.Results Of total 2204 patients,there were statistical differences amongthe4 groupsin severeleukoaraiosis(P<0.001),and H-typehypertension group had the highest rate of severe LA.Age,diabetes,smoking,Lp-PLA2,total cholesterol and H-hypertensionwere independent risk factors of severe LA.At 2 years follow up,more new stroke events occurred in H-type hypertension group(P<0.001),there were no statistical differences amongthe4 groupsin all-cause death(P=0.918).Age,Lp-PLA2,diabetes and H-type hypertension were independent risk factors of new stroke,while age,Lp-PLA2,smoking,diabetes and H-type hypertension were independent risk factors of all-cause death.Conclusion H-type hypertension and Lp-PLA2 were not only the independent risk factors of severeleukoaraiosis but also independent risk factors of new stroke and allcause death at 2 years follow up in LA patients.

关 键 词：脑白质疏松 H型高血压 脂蛋白相关磷脂酶A2 

分 类 号：R743.32[医药卫生—神经病学与精神病学]