老年脑卒中患者血压变异与动脉弹性的相关性研究

Relationship between blood pressure variability and arterial elasticity in elderly patients with stroke

目的探讨老年脑卒中患者血压变异与动脉弹性的相关性。方法选择山东省日照市人民医院神经内科住院部自2014年5月至2016年12月收治的脑卒中患者183例（缺血性脑卒中121例，出血性脑卒中62例），及同期在该院体检的健康人群61例进入试验。所有受试者行24h动态血压监测计算血压变异参数，并检测颈-桡动脉脉搏波传导速度（CrPWV）及颈动脉内膜中层厚度（IMT）及计算僵硬度指数β。结果脑卒中组血压晨峰（MBPS）、收缩压（SBP）标准差、SBP变异系数、夜间收缩压下降率（SBPF）、CrPWV、IMT及僵硬度指数β均明显高于对照组，差异均有统计学意义（P〈0．05）。相关性分析发现：MBPS、SBP标准差、SBP加权标准差、SBP变异系数、SBPF及夜间舒张压下降率（DBPF）与CrPWV、僵硬度指数β相关（P〈0．05），MBPS、SBP标准差、SBP变异系数、SBPF与IMT相关（P〈0．05）。多元线性回归分析结果提示，MBPS、SBP标准差、SBPF等多项血压变异参数是僵硬度指数β、IMT及CrPwV的独立影响因素。结论脑卒中患者血压变异性与动脉弹性相关，降低血压变异性有利于延缓动脉硬化进程。

Objective To explore the correlation between blood pressure variability （BPV） and arterial elasticity in elderly patients with stroke. Methods One hundred and eighty-three stroke patients （121 with cerebral ischemic stroke and 62 with hemorrhagic stroke）, admitted to our hospital from May 2014 to December 2016, and 61 non-stroke individuals were enrolled according to the inclusion and exclusion criterion. Carotid-radial pulse wave velocity （CrPWV） was calculated and carotid artery ultrasound was used to measure intima-media thickness （IMT）; 24 h ambulatory blood pressure monitoring was performed to calculate the BPV parameters. The arterial stiffness index β was calculated. Results As compared with those in the non-stroke subjects, morning blood pressure surge （MBPS）, standard deviation of systolic blood pressure （SBP）, variable coefficient of SBP, systolic blood pressure fall （SBPF）, CrPWV, IMT and stiffness index β in stroke patients were significant increased （P〈0.05）. Correlation analysis indicated that MBPS, standard deviation of SBP, weighted standard deviation of SBP, variance of SBP, variable coefficient of SBP, SBPF, and diastolic blood pressure fall were signficantly correlated with CrPWV and stiffiaess index β（P〈0.05）; IMT was closely related to MBPS, standard deviation of SBP, variable coefficient of SBP, and SBPF （P〈0.05）. Multivariate linear regression analysis showed that MBPS, standard deviation of SBP and SBPF were the independent influencing factors of IMT, CrPWV and stiffness index β. Conclusion BPV showed significant relationship with vascular elasticity in stroke patients, and reduction of BPV helps to delay the process of atherosclerosis.