普通人群中外周血压与颅内动脉血流动力学参数关系的研究

Relationship between blood pressure and hemodynamic parameters of intracranial arteries in general population

目的探讨普通人群中外周血压与颅内动脉血流动力学参数间的关系。方法选择2016年1—10月于空军特色医学中心进行门诊检查的150例志愿者,年龄19~85岁,平均(42.4±13.9)岁,男87例,女63例。记录志愿者一般资料:年龄、身高、体质量、体质量指数(BMI)和双侧上臂臂围(BC)。采用校正的汞柱血压计测量并记录志愿者双侧肱动脉收缩压和舒张压,每侧均测量3次取平均值记为右侧肱动脉收缩压(right brachial artery systolic blood pressure,RSBP)、肱动脉舒张压(right brachial artery diastolic blood pressure,RDBP)和左侧肱动脉收缩压(left brachial artery systolic blood pressure,LSBP)、肱动脉舒张压(left brachial artery diastolic blood pressure,LDBP),依据双侧肱动脉收缩压和舒张压将150例志愿者分为2组:血压正常组(74例)和血压增高组(76例)。采用CompanionⅢ经颅多普勒仪检测双侧大脑中动脉(middle cerebral artery,MCA)、颈内动脉终末段(internal carotid artery,ICA)、大脑前动脉(anterior cerebral artery,ACA)、大脑后动脉(posterior cerebral artery,PCA)、椎动脉(vertebral artery,VA)和基底动脉(base artery,BA)的收缩期峰值血流速度(Vs)、舒张末期血流速度(Vd)、平均血流速度(Vm)、搏动指数(pulsatility index,PI)和阻抗指数(resistant index,RI)的指标,分析血压与颅内动脉血流动力学参数间的关系。结果2组间年龄、体质量、BMI、RBC、RSBP、RDBP、LSBP、LDBP、RICA-PI、RICA-RI、LMCA-PI、LMCA-RI、LPCA-PI、LPCA-RI、RVA-Vd、RVA-Vm、LVA-PI、LVA-RI差异有统计学意义(P<0.05),均为血压增高组高于血压正常组;年龄与双侧MCA、ICA、ACA、VA和BA血管的Vs、Vd、Vm间呈负相关,特别在双侧MCA、ICA、VA和BA血管中相关性显著(P<0.01),与PI、RI呈正相关(P<0.05);身高与LACA、RVA、BA的Vs、Vd、Vm间呈负相关(P<0.05);体质量与LPCA、RVA、LVA、BA的Vs、Vd、Vm间呈负相关(P<0.05);BMI与LPCA、RVA、LVA、BA的Vs、Vd、Vm间呈负相关(P<0.05);血压与颅内动脉Vs、Vd、Vm、PI、RI的相关性不显著。结论不能单纯依靠外周肱动脉处血压的高低间接评估颅内动脉血流动力学状态和功能;在年龄相同的群体中,适当控制体重和血压对维持颅内动脉血流动力学状态和功能有一定益处。

Objective To investigate the relationship between peripheral blood pressure and hemodynamic parameters of intracranial artery in general population.Methods From January to October 2016,150 volunteers,aged from 19 to 85 years old,with an average of(42.4±13.9)years old,were selected for outpatient examination in the Air Force Medical Center,including 87 males and 63 females.The general information of the volunteers was recorded:age,height,weight,body mass index(BMI)and bilateral biceps circumferenc(BC).The systolic and diastolic blood pressures of bilateral brachial arteries were measured and recorded with a calibrated mercury sphygmomanometer.The mean values were recorded as right brachial artery systolic blood pressure(RSBP),right brachial artery diastolic blood pressure(RDBP)and left brachial artery systolic blood pressure(LSBP),left brachial artery diastolic blood pressure(LDBP).According to the systolic and diastolic blood pressure of bilateral brachial arteries,150 volunteers were divided into two groups:normal blood pressure group(74 cases)and high blood pressure group(76 cases).The following index were measured by companionⅢtranscranial doppler instrument:middle cerebral artery(MCA)、internal carotid artery(ICA)、anterior cerebral artery(ACA)、posterior cerebral artery(PCA)、vertebral artery(VA)and base artery(BA),Systolic peak blood flow velocity(VS),end diastolic blood flow velocity(VD),mean blood flow velocity(VM),pulsatility index(PI)and resistant index(RI),The relationship between blood pressure and hemodynamic parameters of intracranial artery was analyzed.Results The differences in age,weight,BMI、RBC、RSBP、RDBP、LSBP、LDBP、RICAPI、RICA-RI、LMCA-PI、LMCA-RI、LPCA-PI、LPCA-RI、RVA-Vd、RVA-Vm、LVA-PI、LVA-RI between the two groups were statistically significant(P<0.05),All of them were higher in high blood pressure group than in normal blood pressure group;there was a negative correlation between age and Vs,Vd and Vm of bilateral MCA,ICA,ACA,VA and BA blood vessel.Especially in bilateral MCA,ICA,VA and BA blood vessel,the correlation was significant(P<0.01),and positively correlated with PI and RI(P<0.05);there was a negative correlation between height and Vs,Vd and Vm of bilateral LACA,RVA and BA blood vessel(P<0.05);there was a negative correlation between body weight and Vs,Vd and Vm of bilateral LACA,RVA and BA blood vessel(P<0.05);there was a negative correlation between BMI and Vs,Vd and Vm of bilateral LACA,RVA and BA blood vessel(P<0.05);there was no significant correlation between blood pressure and Vs,Vd,Vm,PI,RI of intracranial artery.Conclusion The hemodynamic status and function of intracranial artery can not be indirectly evaluated by the blood pressure of peripheral brachial artery;In the same age group,proper control of weight and blood pressure is beneficial to maintain the hemodynamic status and function of intracranial artery.