平均收缩压对非卒中老年病人脑白质病变的影响

Effect of mean systolic blood pressure on cerebral white matter lesion in the non-stroke elderly

目的探讨非卒中老年人脑白质病变(WML)的影响因素。方法回顾性分析2015~2016年江苏省人民医院老年医学科住院的105例非卒中老年病人的临床资料,所有病人均已行头颅MRI检查及动态血压监测,按照头颅MRI结果及Fazekas量表进行评分,将WML分为无-轻度组(0~2分)及中-重度组(3~6分)。对可能与脑白质病变相关的因素及动态血压结果进行组间比较,对存在统计学差异的资料进行Logistic多因素回归分析。结果 WML中-重度组与无-轻度组比较,年龄、性别、高血压史、冠心病史、降压药使用、估算的肾小球滤过率(estimated glomerular filtration rate,e GFR)、24小时平均收缩压(24-hour mean systolic blood pressure,24hm SBP)、白天平均收缩压(daytime mean systolic blood pressure,Dm SBP)、夜间平均收缩压(nighttime mean systolic blood pressure,Nm SBP)差异有统计学意义(P<0.05或P<0.01),Logistic回归分析表明年龄和24hm SBP是WML的危险因素(P<0.05)。结论高龄以及24hm SBP增高是WML的危险因素。对于以收缩压升高为特征的老年人,严格控制血压可能有助于预防WML的发生及进展。

Objective To investigate the risk factors of cerebral white matter lesion（ WML） in the non-stroke elderly. Methods The general clinical data of 105 elderly patients admitted in Department of Geriatrics,Jiangsu Province Hospital during 2015-2016 were retrospectively analyzed.Cerebral MRI and ambulatory blood pressure monitoring were checked in all patients. According to MRI and Fazekas rating scale,all patients were divided into the absent-mild WML group（ 0-2 points） and the moderate-severe group（ 3-6 points）. Clinical data that may be related to WML and the results of 24-hour ambulatory blood pressure monitoring were compared between two groups respectively. The factors presenting significant difference were then taken into Logistic regression analysis. Results Compared to absent-mild WML group,the moderate-severe WML group showed advanced age,more female,more history of hypertension and coronary heart disease,less utility of combined antihypertensive drugs,lower e GFR,higher 24 hm SBP,Dm SBP and Nm SBP with a statistical significance（ P〈0. 05） respectively.Logistic regression analysis demonstrated that advanced age and higher 24 hm SBP were independent risk factors of WML. Conclusions Advanced age and higher 24 hm SBP are independent risk factors of WML in the non-stroke elderly. It will contribute to the occurrence and progression of WML in the nonstroke elderly by controlling blood pressure strictly with the fact that high SBP is common in the elderly.