动态血压与急性缺血性卒中患者脑白质病变的关系

Correlation Study of Ambulatory Blood Pressure and White Matter Lesions in Acute Ischemic Stroke Patients

目的 探讨动态血压相关指标（ABPM）与急性缺血性卒中患者脑白质病变（WMLs）的关系。方法 选择辽宁省人民医院神经内科2012年7月到2014年12月住院治疗的高血压性非心源性栓塞的急性缺血性卒中患者76例,卒中后1～2周内进行ABPM监测及头MRI检查,根据是否存在WMLs,将患者分成2组,有WMLs的作为病例组（36例）,无WMLs的作为对照组（40例）。采集一般临床资料,包括年龄、性别、糖尿病史、高脂血症史、吸烟史、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、血糖、纤维蛋白原、同型半胱氨酸等指标及头部MRI影像学资料,并进行ABPM参数的比较。结果 年龄、24 h平均收缩压、白天平均收缩压、夜间平均收缩压、夜间平均舒张压、24 h平均脉压病例组和对照组比较差异有统计学意义（均P〈0.05）。多因素Logistic回归分析显示WMLs的独立危险因素是年龄（OR=0.914,95%CI 0.858～0.975,P=0.006）、24 h平均收缩压（OR=0.810,95%CI 0.651～0.908,P=0.039）、夜间平均舒张压（OR=0.937,95%CI 0.880～0.997,P=0.041）。结论 年龄、24 h平均收缩压、夜间平均舒张压是急性缺血性卒中患者WMLs的重要危险因素。

Objective To describe the association between white matter lesions （WMLs） and ambulatory blood pressure monitoring （ABPM） parameters in acute ischemic stroke patients. Methods A total of 76 noncardioembolic ischemic stroke patients with hypertention admitted from July 2012 to December 2014 were recruited. These patients had 1 week of suffering a stroke, and received ABPM and MRI 1 or 2 weeks after stroke onset. The subjects were classified into 2 groups according to the presence of WMLs ： with WMLs group （ n =36）, without WMLs group （ control group, n = 40）. The clinical data of these patients were collected, including age, gender, history of diabetes, history of hyperlipidemia, history of smoking, total cholesterol, high- density lipopmtein, low- density lipepmtein, triglyceride, blood glucose, and homocysteine. Their ABPM parameters were compared. Results Age, 24-hour SBP, awake, and asleep systolic blood pressure （SBP）/diastolic blood pressure levels and 24-hour pulse pressure were associated with advanced WMLs. After adjustments, old age （ OR =0.914,95% CI 0.858-0.975, P = 0.006）, high 24-hour SBP levels （ OR = 0.810,95%CI 0.651-0.908, P = 0.039）, and asleep DBP （ OR =0.937,95%CI 0.880-0.997, P = 0.041 ） were independently risk factors for WMLs in stroke patients. Conclusion Age, higher 24-hour SBP and asleep DBP are correlated with WMLs in ischemic stroke patients.