血压变异性与脑微出血的相关性研究

Relationship between blood pressure variability and cerebral microbleeds

目的 探讨血压变异性与急性缺血性卒中患者脑微出血（cerebral microbleeds,CMBs）的相关性。方法回顾性分析急性缺血性卒中患者164例,根据头颅MRI结果分为CMBs组（78例）和非CMBs组（86例）。患者完成24 h动态血压监测,包括24 h平均收缩压（24h SBP）、24 h平均舒张压（24h DBP）、日间平均收缩压（DSBP）、日间平均舒张压（DDBP）、夜间平均收缩压（NSBP）、夜间平均舒张压（NDBP）;血压变异性（BPV）包括日间收缩压标准差（DSBP-SD）和日间舒张压标准差（DDBP-SD）、夜间收缩压标准差（NSBP-SD）、夜间舒张压标准差（NDBP-SD）、日间收缩压变异系数（DSBP-CV）、日间舒张压变异系数（DDBP-CV）、夜间收缩压变异系数（NSBP-CV）、夜间舒张压变异系数（NDBP-CV）。比较两组间动态血压相关参数。结果 CMBs组24 h SBP、DSBP、DSBP-CV、NDBP、NDBP-CV高于非CMBs组,差异有统计学意义（P〈0.05）。Logistic回归分析显示DSBP-CV（OR=1.245,95%CI：1.032~1.504,P=0.022）、NDBP-CV（OR=1.323,95%CI：1.195~1.464,P=0.000）是脑深部CMBs的危险因素,NDBP-CV（OR=1.102,95%CI：1.022~1.189,P=0.012）是幕下CMBs的独立危险因素。结论 血压变异性是CMBs的重要影响因素,其中DSBP-CV、NDBP-CV是脑深部CMBs的独立危险因素,NDBP-CV是幕下CMBs的独立危险因素。

Objective To investigate the correlation between blood pressure variability （BPV） and cerebral micro- bleeds （CMBs）. Methods A total of 164 patients were analyzed, who were suffered from acute ischemic stroke. Patients were divided into two groups. One was CMBs group （n=78）, the other was non-CMBs group （n=86） according to the susceptibility weighted imaging （SWI）. The ambulatory blood pressure monitoring was used to measure the blood pressure level parameters, including 24 h systolic blood pressure （24-SBP）, 24 h diastolic blood pressure （24-DBP）, day-time sys- tolic blood pressure （DSBP）, day-time diastolic blood pressure （DDBP）, night systolic blood pressure （NSBP）, night diastolic blood pressure （NDBP）. The BPV included the standard deviation of DSBP （DSBP- SD）, NSBP- SD, DDBP- SD, NDBP-SD and the coefficient of variation of DSBP （DSBP-CV）, NSBP-CV, DDBP-CV, NDBP-CV. The differences of the ambulatory blood pressure parameters were compared between the 2 groups. Results Patients with CMBs were more likely to have higher 24 h SBP, DSBP, DSBP-CV, NDBP, NDBP-CV than patients without CMBs. The difference was significant （P 〈 0.05）. Logistic regression analysis indicated that DSBP-CV （OR=1.245, 95%CI 1.032-1.504, P = 0.022） and NDBP-CV （OR=1.323, 95%CI 1.195-1.464, P = 0.000） were the independent risk factors of CMBs in deep region. NDBP-CV （OR=1.102, 95%CI 1.022-1.189, P = 0.012） was the independent risk factor of CMBs in infratentorial location. Conclusion The BPV is an important influencing factor for CMBs, DSBP-CV,NDBP-CV are independently risk factors for CMBs in deep region and NDBP-CV is the independent factor for infratentorial location.