缺血性脑血管病患者脑动脉粥样硬化性狭窄与血压变异性的关系分析

Analysis of the relationship between cerebral artery atherosclerotic stenosis and blood pressure variability in patients with ischemic cerebrovascular disease

目的 探讨缺血性脑血管病患者脑动脉粥样硬化性狭窄与血压变异性的关系。方法 选择2011年10月至2014年10月入住山东省泰安市中心医院神经内科的212例缺血性脑血管病患者作为研究对象,对其进行连续主动脉弓联合全脑血管造影检查,并作24 h动态血压监测。对影响缺血性脑血管病患者脑动脉粥样硬化性狭窄的心血管因素进行分析,并分别采用单因素与多元Logistic回归分析法对脑动脉粥样硬化性狭窄与血压变异性的相关性进行分析。结果 （1）影响缺血性脑血管病患者脑动脉粥样硬化性狭窄的心血管因素包括：年龄、糖尿病病程、血脂异常病史、血脂异常病程、高血压病程、空腹血糖（FBG）、总胆固醇（TC）及低密度脂蛋白胆固醇（LDL-C）（χ^2=12.369,P〈0.01;χ^2=9.381,P〈0.01;χ^2=10.285,P〈0.01;χ^2=12.420,P〈0.01;χ^2=11.085,P〈0.01;χ^2=10.027,P〈0.01;χ^2=5.082,P〈0.05;χ^2=4.398,P〈0.05）;（2）经单因素分析,收缩压（SBP）变异系数、平均SBP、平均舒张压（DBP）及平均动脉压均与缺血性脑血管病患者脑动脉粥样硬化性狭窄有关（χ^2=14.691,P〈0.01;χ^2=12.863,P〈0.01;χ^2=13.242,P〈0.01;χ^2=5.986,P〈0.05）;（3）经多元Logistic回归分析,缺血性脑血管病患者脑动脉粥样硬化性狭窄与SBP变异系数（β=0.442,Wald=5.389,P=0.034,OR=1.559,95%CI 1.372~1.903）、平均SBP（β=0.159,Wald=4.671,P=0.029,OR=1.021,95%CI 0.953~1.132）相关。结论 在缺血性脑血管病患者中,关注血压变异,可有效预防脑动脉粥样硬化性狭窄的发生,从而改善缺血性脑血管病患者的预后状况。

Objective To investigate the relationship between cerebral artery atherosclerotic stenosis and blood pressure variability in patients with ischemic cerebrovascular disease. Methods 212 cases of patients with ischemic cerebrovascular disease were selected as the research object from October 2011 to October 2014 in the Department of Neurology in Taian City Central Hospital. Its continuous aortic arch combined with all cerebral angiography, and for 24 h ambulatory blood pressure monitoring. Factors that affected ischemic brain cerebral artery atherosclerotic stenosis in patients with cardiovascular disease were analyzed and the correlation of the cerebral artery atherosclerotic stenosis associated with blood pressure variabihty were analyzed by univariate and multivariate Logistic regression. Results （ 1 ） Ischemic brain cerebral artery atherosclerotic stenosis in patients with cardiovascular disease factors included： age, duration of hypertension, fasting plasma glucose （ FBG）, total cholesterol （TC） and low density lipoprotein-cholestrol （LDL-C） （χ^2 =12. 369,P〈0.01;χ^2 =9.381, P〈0.01; χ^2=10.285,P〈0.01;χ^2=12.420,P〈0.01; χ^2=11.085,P〈0.01; χ^2= 10.027,P〈0.01; χ^2=5.082,P〈0.05;χ^2 =4.398; P〈0.05）; （2） By univariate analysis, systolic blood pressure （SBP） variation coefficient the average SBP, mean diastolic blood pressure （DBP） and mean arterial pressure were associated with atherosclerotic artery stenosis in patients with ischemic cerebrovascular disease（χ^2 = 14. 691, P 〈 0. 01 ; χ^2 12. 863, P 〈 0.01 ;χ^2= 13. 242, P 〈 0. 01 ; χ^2= 5. 986, P 〈 0. 05 ） ; （ 3 ） By Logistic regression analysis, ischemic cerebrovascular disease cerebral artery atheroselerotic stenosis was correlated with SBP variation coefficient （β = 0. 442, Wald = 5. 389,P =0. 034,OR = 1. 559,95% CI 1. 903-1. 372） and the average SBP （β =0. 159,Wald =4. 671 ,P = 0. 029, OR = 1. 021,95% CI 0. 953-1. 132 ）. Conclusion In patients with ischemie cerebrovascular disease,blood pressure variability concerns can be effective in preventing incidence of cerebral artery atherosclerotic stenosis,thereby improving the prognosis for patients with ischemic cerebrovaseular disease.