降压治疗与高血压性脑出血患者脑白质病变严重程度的相关性

The correlation between severity of white matter lesions and antihypertensive treatment in patients with hypertensive intracerebral hemorrhage

目的探讨高血压性脑出血患者中脑白质病变(WMLs)严重程度与降压治疗的相关性。方法纳入2016年5月至2019年5月丽水市中心医院登记住院的高血压性脑出血患者212例,其中有182例患者存在不同严重程度的WMLs而被纳入分析。收集患者基线资料。基于多田公式计算脑出血血肿体积。根据Fazekas评分标准分别评估脑室旁白质(0~3分)和深部白质病变(0~3分)程度,两项得分之和即为总的WMLs评分。以WMLs严重程度将患者分为轻度(1~2分)和中重度(3~6分)。运用单因素和多因素Logistic回归分析降压治疗与WMLs严重程度的关系。结果85.85%高血压性脑出血患者存在不同程度的WMLs。轻度组与中重度组比较年龄、脑梗死/短暂性脑出血发作史、降压药使用以及降压药使用达标差异有统计学意义(t/χ^2=-3.996、5.526、11.330、11.334,均P<0.05)。将有统计学意义的指标纳入多因素Logistic分析,结果表明年龄(OR=1.053,95%CI=1.016~1.081;P<0.05)是WMLs的独立危险因素,降压药使用(OR=0.442,95%CI=0.233~0.817;P<0.05)、降压药使用达标(OR=0.339,95%CI=0.217~0.813;P<0.05)是WMLs的独立保护因素。结论降压治疗是高血压性脑出血患者WMLs的保护因素。

Objective To explore the association between the severity of white matter lesions(WMLs)and antihypertensive treatment in patients with hypertensive intracerebral hemorrhage.Methods 212 patients with hypertensive intracerebral hemorrhage who were hospitalized in Lishui central hospital between May 2016 and May 2019 were enrolled,among whom 182 individuals with varying severity of WMLs were finally included.The baseline data were collected.The volumes of hematomas were calculated by Dotian fomula.Periventricular WML and deep WML were assessed respectively according to Fazekas scale with scores from 0 to 3.The sum of the two scores was the total WMLs score.Patients were divided into mild(1~2 points)and moderate to severe(3~6 points)by the severity of WMLs.The association between the severity of WMLs and antihypertensive treatment were analyzed by univariate and multivariate Logistic analysis.Results 85.85%of hypertensive intracerebral hemorrhage patients have varying degrees of WMLs.Compared with moderate to severe group,age,history of cerebral infarction/TIA,use of antihypertensive drugs and standardized blood pressure after treatment in the mild group were statistically significant different(t/χ^2=-3.996,5.526,11.330,11.334;all P<0.05).The above statistically significant indicators were included in the multivariate Logistic analysis.The results showed that age(OR=1.053,95%CI=1.016-1.081;P<0.05)was an independent risk factor for WMLs,use of antihypertensive drugs(OR=0.442,95%CI=0.233-0.817;P<0.05)and standardized blood pressure after treatment(OR=0.339,95%CI=0.217-0.813;P<0.05)were independent factors related to the severity of WMLs.Conclusion Antihypertensive therapy is a protective factor of WMLs in patients with hypertensive intracerebral hemorrhage.