H型高血压患者颅内、外段动脉硬化相关危险因素分析

Relative risk factors analysis of intracranial and extracranial arteriosclerosis in patients with H-type hypertension

目的探讨H型高血压患者颅外动脉硬化及颅内动脉硬化的相关因素,为H型高血压患者缺血性脑卒中的一级预防、二级预防提供依据。方法回顾性分析2010~2012年中山大学附属东华医院诊断为H型高血压病合并脑梗死患者173例的临床资料,其中以颅外动脉硬化为主者114例,以颅内动脉硬化为主者59例,二者均存在者24例。研究变量包括性别、既往病史（高血压、糖尿病、冠心病、房颤、高血压心脏病、烟雾病、偏头痛）、家族史、长期吸烟、长期饮酒、胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、C反应蛋白、血糖、血同型半胱氨酸、血尿酸。结果颅外段动脉硬化患者和颅内段动脉硬化患者的糖尿病、冠心病、家族史、吸烟、酗酒及胆固醇、高密度脂蛋白、低密度脂蛋白、血糖、血尿酸、血同型半胱氨酸、C反应蛋白水平差异均无统计学意义（P〉0.05）;颅外段动脉硬化患者和颅内段动脉硬化患者的年龄、高血压心脏病、三酰甘油水平比较,差异有统计学意义（P〈0.05）。多元回归分析显示：性别（男性）、年龄、高血压心脏损害的出现与颅外段动脉硬化有显著相关性（P〈0.05）;年龄（≥60岁）、性别（男性）、吸烟均与颅内动脉硬化有显著相关性（P〈0.05）。结论对于H型高血压病患者,年龄（≥60岁）、性别（男性）是颅内及颅外动脉硬化的危险因素。高血压心脏损害的出现及高三酰甘油血症对H型高血压颅外段动脉硬化的发生有重要意义。

Objective To investigate relative factors for extracranial arteriosclerosis and intracranial arteriosclerosis in patients with H-type hypertension, in order to provide evidence for primary and secondary prevention of ischemic stroke in patients with H-type hypertension. Methods The clinical data of 173 patients with H-type hypertension in Donghua Hosptial Affiliated to Sun Yat-sen University from 2010 to 2012 were retrospectively analyzed, including 114 cases predominated with extracranial arteriosclerosis, 59 cases predominated with intracranial arteriosclerosis, and 24 cases with concurrence of both types. The study variables included gender, prior medical history（hypertensions, diabetes mellitus, coronary heart disease, atrial fibrillation, hypertensive heart disease, Moyamoya disease, and migraine）,family history, long-term smoking, long-term alcohol intake, cholesterol, triglyceride, high density lipoprotein, low density lipoprotein, C reactive protein, blood glucose, blood uric acid, and homocysteine. Results Diabetes mellitus, coronary heart disease, family history, smoking, alcohol abuse, cholesterol, high density lipoprotein, low density lipoprotein,blood glucose, blood uric acid, homocysteine, or C reactive protein of patients with extracranial arteriosclerosis and patients with intracranial arteriosclerosis were compared, the differences were not statistically significant（P〈0.05）; age,hypertensive heart disease, triglyceride of patients with extracranial arteriosclerosis and patients with intracranial arteriosclerosis were compared, the differences were statistically significant（P〈0.05）. Multiple regression analysis showed that extracranial arteriosclerosis had significant correlations with gender（male）, age（≥60 years）, presence of hypertensive heart injury and smoking（P〈0.05）; intracranial arteriosclerosis had significant correlation with age（≥60 years）, gender（male） and smoking presented（P〈0.05）. Conclusion For patients with H-type hypertension, age（≥60 years） and gender（male） are the risk factors for both intracranial and extracranial arteriosclerosis. Presence of hypertensive heart injury and hypertriglyceridemia are significant for the development of extracranial arteriosclerosis in H-type hypertension.