脑小血管病动态血压变异性与脑小血管病影像总负荷的相关性  

The relationship between 24-hour ambulatory blood pressure variability and total imaging burden of cerebral small vessel disease in patients with cerebral small vessel disease

作　　者：段雅鑫 滕振杰[1] 胡明[1] 赵岩[1] 成斯琪 裴晗蕾 吕佩源[1] DUAN Yaxin;TENG Zhenjie;HU Ming;ZHAO Yan;CHENG Siqi;PEI Hanlei;LYU Peiyuan(Hebei General Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北省人民医院神经内科,石家庄050051

出　　处：《中国神经精神疾病杂志》2022年第6期321-327,共7页Chinese Journal of Nervous and Mental Diseases

基　　金：2019年河北省政府资助临床医学优秀人才培养项目(编号:2019-139-5);2020年河北省引进国外智力项目(编号:2020-19-2)。

摘　　要：目的探讨脑小血管病(cerebral small vessel disease,CSVD)患者24 h动态血压变异性(blood pressure variability,BPV)与CSVD影像总负荷的关系。方法纳入2016年10月至2020年10月于河北省人民医院神经内科住院且入院后10 d内完成头颅磁共振成像(magnetic resonance imaging,MRI)及24 h动态血压监测(ambulatory blood pressure monitoring,ABPM)的CSVD患者。收集患者的一般资料,根据头颅MRI评估CSVD影像总负荷(0~4分),并按此将患者分为轻中度组(0~2分)和重度组(3~4分)。记录ABPM结果并计算动态血压相关参数。分析动态血压相关参数与CSVD影像总负荷之间的关系。结果共纳入患者326例,轻中度组183例,重度组143例。重度组年龄[(68.0±12.3)岁vs.(62.2±12.0)岁,P<0.001]、同型半胱氨酸水平[16.22(12.50,18.86)mmol/L vs.13.30(11.00,16.22)mmol/L,P<0.001]、24 h平均收缩压[(148.75±17.63)mmHg vs.(144.47±17.82)mmHg,P=0.031]、夜间平均收缩压[(145.14±20.54)mmHg vs.(139.27±20.26)mmHg,P=0.010]、24 h收缩压加权标准差[16.89%(14.09%,20.16%)vs.15.37%(13.02%,18.63%),P=0.013]、24 h舒张压加权标准差[11.55%(9.53%,13.76%)vs.10.37%(8.54%,13.18%),P=0.040]、夜间收缩压标准差(standard deviation of nighttime systolic blood pressure,NSBP-SD)[15.77%(12.07%,21.56%)vs.14.11%(10.42%,17.81%),P<0.001]高于轻中度组患者,载脂蛋白A水平[(1.25±0.25)mmol/L vs.(1.30±0.21)mmol/L,P=0.039]低于轻中度组患者,且重度组男性(65.73%vs.54.10%,P=0.034)、既往脑梗死(34.27%vs.14.21%,P<0.001)、非杓型血压(81.82%vs.70.49%,P=0.018)患者所占比例较轻中度组高;Spearman相关分析示:NSBP-SD与CSVD影像总负荷呈正相关(r=0.203,P<0.001),夜间SBP下降率与CSVD影像总负荷呈负相关(r=-0.204,P<0.001);logistic回归分析示:既往脑梗死(OR=2.700,95%CI:1.512~4.822,P=0.001)、NSBP-SD(OR=1.085,95%CI:1.041~1.131,P<0.001)、年龄(OR=1.034,95%CI:1.013~1.055,P=0.001)、男性(OR=1.856,95%CI:1.132~3.041,P=0.014)、非杓型血压(OR=1.974,95%CI:1.106~3.522,P=0.Objective To explore the relationship between 24-hour ambulatory blood pressure variability(BPV)and total imaging burden of cerebral small vessel disease(CSVD)in patients with CSVD.Methods Inpatients with CSVD from the neurology department in Hebei General Hospital from October 2016 to October 2020 were selected in our study,all of whom completed cranial magnetic resonance imaging(MBI)and 24-hour ambulatory blood pressure monitoring(ABPM)within 10 days after admission.The general data of the patients were collected,and the total imaging burden of the patients were evaluated(0-4 points)based on the cranial MRI.According to the total imaging burden of CSVD,the patients were divided into mild-to-moderate group(0-2 points)and severe group(3-4 points).Meanwhile,the related parameters of ambulatory blood pressure were recorded and calculated,according to the results of 24-hour ABPM.Results A total of 326 patients were enrolled in the study including 183 in the mild-to-moderate group and 143 in the severe group.The ages(68.0±12.3 vs.62.2±12.0,P<0.001),levels of homocysteine[16.22(12.50,18.86)mmol/L vs.13.30(11.00,16.22)mmol/L,P<0.001],24-hour mean systolic blood pressure[(148.75±17.63)mmHg vs.(144.47±17.82)mmHg,P=0.031],nighttime mean systolic blood pressure[(145.14±20.54)mmHg vs.(139.27±20.26)mmHg,P=0.010],weighted standard deviation of 24-hour systolic blood pressure[16.89%(14.09%,20.16%)vs.15.37%(13.02%,18.63%),P=0.013],weighted standard deviation of 24-hour diastolic blood pressure[11.55%(9.53%,13.76%)vs.10.37%(8.54%,13.18%),P=0.040],standard deviation of nighttime systolic blood pressure(NSBP-SD)[15.77%(12.07%,21.56%)vs.14.11%(10.42%,17.81%),P<0.001]were higher in the severe group than in the mild-to-moderate group,while the levels of apolipoprotein A[(1.25±0,25)mmol/L vs.(1.30±0.21)mmol/L,P=0.039]were lower.The composition ratios of male(65.73%vs.54.10%,P=0.034),previous history of cerebral infarction(34.27%vs.14.21%,P<0.001)and non-dipping pattern(81.82%vs.70.49%,P=0.018)were higher in the severe group th

关 键 词：脑小血管病 总负荷 危险因素 磁共振成像 动态血压 血压变异性 非杓型血压 

分 类 号：R743[医药卫生—神经病学与精神病学]