老年人脑微出血与收缩压晨峰的相关性

Relationship between cerebral microbleeds with morning SBP surge in the elderly

目的探讨收缩压晨峰对老年人脑微出血(CMB)的影响。方法 2008年4月~2009年10月于山东省医学科学院心脑血管病防治研究中心选择年龄≥60岁的健康体检的老年人408例。采用24h动态血压监测血压晨峰,根据收缩压晨峰,将受试者分为晨峰组169例[收缩压晨峰≥35mm Hg(1mm Hg=0.133kPa)]和非晨峰组239例(收缩压晨峰<35mm Hg)。分别于2008~2009年(基线)、2010~2012年(随访)和2013~2015年(随访)共进行3次头颅MRI检查评估CMB。患者随访39~72(62.04±6.80)个月,将随访与基线比较,有新发CMB定义为CMB进展。用logistic回归分析影响因素,用Kaplan-Meier生存函数曲线分析,用多元Cox生存回归分析。结果晨峰组诊室收缩压、24h平均收缩压、昼间平均收缩压、昼间平均舒张压、收缩压晨峰、舒张压晨峰和LDL-C水平及CMB患病率显著高于非晨峰组(P<0.05,P<0.01)。logistic回归分析在校正相关混杂因素后,晨峰组患CMB的危险显著高于非晨峰组(OR=2.561,95%CI:1.142~5.743,P=0.019)。晨峰组累积CMB进展率显著高于非晨峰组(18.5%vs 7.6%,χ^2=7.954,Plog-rank=0.005)。在校正包括基线有无CMB在内的相关混杂因素后,晨峰组发生CMB进展的风险显著增高,是非晨峰组的2.353倍(95%CI:1.317~3.197,P=0.002)。结论收缩压晨峰是CMB患病及进展的独立危险因素,过高的收缩压晨峰促进老年人CMB的发展。

Objective To study the effect of morning SBP surge on microbleeds(CMB)in the elderly.Methods Four hundred and eight persons aged≥60 years admitted from April 2008 to October 2009 were divided into morning SBP surge(≥35 mm Hg)group(n=169)and non-morning SBP surge(<35 mm Hg)group(n=239).Their 24 morning SBP surge was mornitorted.The patients underwent 3 times of brain magnetic resonance imaging for the assessment of their CMB and were followed up for 39-72(62.04±6.80)months,during which the new CMB were defined as progressive CMB.The influencing factors of morning SBP surge were analyzed by logistic regression analysis,Kaplan-Meier survival function curve analysis and multivariate Cox survival regression analysis respectively.Results The SBP,24 hmean SBP,day mean SBP and DBP,morning SBP and DBP surge,serum LDL-C level and incidence of CMB were significantly higher in morning SBP surge group than in non-morning SBP surge group(P<0.05,P<0.01).The risk of CMB was significantly higher in morning SBP surge group than in non-morning SBP surge group after adjustment for the confounding factors(OR=2.561,95%CI:1.142-5.743,P=0.019).The accumulated progressive rate of CMB was significantly higher in morning SBP surge group than in non-morning SBP surge group(18.5%vs 7.6%,Plog rank=0.005).The risk of progressive CMB was 2.353-fold higher in morning SBP surge group than in non-morning SBP surge group after adjustment for the confounding factors(95%CI:1.317-3.197,P=0.002).Conclusion Morning SBP surge is an independent risk factor for CMB and their progression.High morning SBP surge aggravates the progression of CMB in the elderly.