老年脑微出血患者的动态血压特点及危险因素分析  

Features of ambulatory blood pressure and risk factors of the elderly patients with cerebral microbleeds

作　　者：李慧颖 李春林[2] 于生元[3] 刘宏斌[1] 邱峰 Li Huiying;Li Chunlin;Yu Shengyuan;Liu Hongbin;Qiu Feng(Department of Cardiology,Second Medical Center&National Clinical Research Center for Geriatric Disease,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第二医学中心心内科,国家老年疾病临床医学研究中心,北京100853 [2]解放军总医院第八医学中心健康医学科 [3]解放军总医院第一医学中心神经内科医学部

出　　处：《中华老年心脑血管病杂志》2022年第12期1236-1239,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：国家重点研发计划项目(2020YFC2008304);军队保健专项重点项目(22BJZ26);军队技术标准重点项目(20BJZ38)。

摘　　要：目的探讨老年高血压患者24h动态血压特点与脑微出血(CMB)之间的关系,分析CMB的危险因素。方法连续选择2018年1月至2021年8月于解放军总医院第二医学中心和第八医学中心行24 h动态血压监测及头颅磁共振检查的老年高血压患者585例,根据头颅磁共振检查结果分为CMB组(184例)和非CMB组(401例)。分析2组基线资料以及24 h动态血压各参数之间的差异,用多因素logistic回归分析老年高血压患者发生CMB的危险因素。结果CMB组患者年龄高于非CMB组[(82.34±8.46)岁vs(79.29±9.10)岁,P=0.000],血红蛋白水平低于非CMB组[(130.04±15.54)g/L vs(133.38±16.45)g/L,P=0.021];CMB组24 h平均收缩压、24 h平均动脉压、24 h平均脉压差、昼间平均收缩压、昼间平均脉压差、夜间平均收缩压、夜间平均动脉压、夜间平均脉压差、24 h收缩压标准差、24 h收缩压升高时间百分比均显著高于非CMB组,收缩压夜间下降率、舒张压夜间下降率显著低于非CMB组,差异均有统计学意义(P<0.05,P<0.01)。多因素logistic回归分析显示,年龄、夜间平均收缩压升高及服用抗栓药物是发生CMB的独立危险因素(P<0.01)。结论高龄、夜间平均收缩压增高、服用抗血小板药物与老年高血压患者发生CMB相关,24 h血压变异性指标与老年CMB无显著关联。Objective To explore the relationship between features of 24 h ambulatory blood pres-sure(ABP)and cerebral microbleeds(CMB)in elderly patients with hypertension,and to analyze the risk factors of CMB.Methods A total of 585 consecutive elderly hypertension patients who underwent 24 h ABP monitoring and cranial magnetic resonance imaging scans in the Second and Eighth Medical Center of Chinese PLA General Hospital from January 2018 to August 2021 were enrolled in this study.According to their cranial magnetic resonance images,they were divided in-to CMB group(184 cases)and non-CMB group(401 cases).The differences in their baseline data and 24 h ABP parameters were analyzed between the 2 groups.The risk factors of CMB in elderly patients with hypertension were identified by multivariate logistic regression model.Results The CMB group had significnatly older average age(82.34±8.46 years vs 79.29±9.10 years,P=0.000)and lower hemoglobin level(130.04±15.54 g/L vs 133.38±16.45 g/L,P=0.021)than the non-CMB group.In term of 24 h ABP parameters,24 h mean systolic blood pressure,24 h mean arterial pressure,24 h mean pulse pressure,daytime/nocturnal mean systolic blood pres-sure,daytime/nocturnal mean pulse pressure,nocturnal mean arterial pressure,24 h systolic pres-sure standard deviation,and percent time elevation of 24 h systolic blood pressure were statistically higher,while nocturnal fall rates in systolic and diastolic blood pressures were notably lower in the CMB group than the non-CMB group(P<0.05,P<0.01).Multivariate logistic regression analysis showed that age,elevated nocturnal mean systolic blood pressure and oral antiplatelet therapy were independent risk factors of CMB in elderly patients with hypertension(P<0.01).Conclusion Advanced age,elevated nocturnal mean systolic blood pressure and taking antiplate-let drugs are associated with CMB in the elderly patients with hypertension,while the variability indicators in 24 h ABP have no such association.

关 键 词：脑出血 血压监测 便携式 磁共振成像 高血压 血红蛋白测定 

分 类 号：R743.34[医药卫生—神经病学与精神病学]