H型高血压患者脑白质病变和脑血流动力学的特点

Characteristics of White Matter Lesions and Cerebral Hemodynamics in Patients with H Type Hypertension

目的探讨H型高血压患者脑白质病变(white matter lesions,WML)和脑血流动力学的特点。方法回顾性纳入连云港市第二人民医院神经内科住院的WML伴高血压患者,根据Hcy水平,分成H型高血压组和单纯高血压组。所有患者行MRI检查并采用Fazekas量表评估WML严重程度,TCD检测颅内动脉并分析其搏动指数(pulsatility index,PI)、平均血流速度(mean blood flow velocity,Vm)等血流动力学特点。对比分析两组患者WML严重程度和脑血流动力学特点。以正常PI值(0.65~1.10)为界,将研究对象分为PI正常组与增高组(>1.10),采用Logistic回归分析其影响因素。结果最终入组217例WML伴高血压患者,年龄40~85岁,平均66.35±8.08岁,男性150例(69.1%)。其中H型高血压组患者131例(60.4%)。H型高血压组总体脑白质Fazekas评分高于单纯高血压组(2.45±0.33 vs 2.16±0.36分,P=0.011);脑室旁Fazekas评分也高于单纯高血压组(1.48±0.12 vs1.38±0.15分,P=0.009);两组患者深部白质Fazekas评分差异无统计学意义。H型高血压组大脑中动脉PI值(1.21±0.20 vs 1.10±0.17,P=0.016)和大脑前动脉PI值(1.16±0.18 vs 1.07±0.18,P=0.023)均高于单纯高血压组。Logistic回归分析显示,H型高血压是大脑中动脉PI值(OR 2.080,95%CI 1.073~4.033,P=0.030)、大脑前动脉PI值(OR 1.951,95%CI 1.015~3.749,P=0.045)的独立影响因素。结论H型高血压与WML的严重程度有关,是大脑中动脉、大脑前动脉PI值的独立影响因素。

Objective To investigate the characteristics of white matter lesions(WML)and cerebral hemodynamics in patients with H type hypertension.Methods WML patients with hypertension in the Second People’s Hospital of Lianyungang were retrospectively analyzed.According to the level of Hcy,the selected patients were divided into H type hypertension group and simple hypertension group.The severity of WML was evaluated by MRI and the Fazekas scale.Intracranial arteries were detected by TCD and their hemodynamic characteristics such as pulsatility index(PI)and mean blood flow velocity(Vm)were analyzed.The severity of WML and the characteristics of cerebral hemodynamics were compared between the two groups.Based on the normal PI(0.65-1.10),all the patients were divided into the normal PI group and increased PI group(>1.10).Logistic regression was used to analyze the influencing factors for PI.Results Finally,a total of 217 WML patients with hypertension were enrolled in this study,aged 40-85 years,with an average age of 66.35±8.08 years and 150 males(69.1%).Among them,131 patients(60.4%)were in the H type hypertension group.The total Fazekas score of H type hypertension group was higher than that of simple hypertension group(2.45±0.33 vs 2.16±0.36,P=0.011),and the paraventricular Fazekas score was also higher than that of simple hypertension group(1.48±0.12 vs 1.38±0.15,P=0.009).There was no statistical difference in deep white matter Fazekas score between the two groups.Middle cerebral artery(MCA)PI(1.21±0.20 vs 1.10±0.17,P=0.016)and anterior cerebral artery(ACA)PI(1.16±0.18 vs 1.07±0.18,P=0.023)in H type hypertension group were higher than that in simple hypertension group.Logistic regression analysis showed that H type hypertension was an independent influence factor of ACA PI(OR 2.080,95%CI 1.073-4.033,P=0.030)and MCA PI(OR 1.951,95%CI 1.015-3.749,P=0.045).Conclusions H type hypertension is related to the severity of WML,and H type hypertension is an independent influence factor for ACA PI and MCA PI.