急性缺血性脑卒中患者脑白质病变与血压变异性的相关性

Correlation between cerebral white matter lesions and blood pressure variability in patients with acute ischemic stroke

目的分析急性缺血性脑卒中患者脑白质病变与血压变异性的相关性。方法回顾性分析清华大学附属北京清华长庚医院2019年1月至11月入院的急性缺血性脑卒中患者,通过Fazekas方法半定量评估患者脑白质病变严重程度,将入组患者分为显著脑白质病变组及轻度脑白质病变组;通过24 h动态血压监测评估患者的昼夜血压变异性。采用单因素和多变量逻辑回归分析影响急性缺血性脑卒中人群脑白质病变的相关因素。结果本研究共纳入90例患者,年龄(66.2±11.9)岁,其中女性26例;37.8%(34/90)的病例为显著脑白质病变;昼-夜收缩压下降率为(3.4±8.0)%,75.6%(68/90)的患者具有异常昼-夜收缩压下降,昼-夜舒张压下降率为(6.0±8.3)%,70.0%(63/90)的患者具有异常昼-夜舒张压下降。年龄(OR=0.887,95%CI:0.829~0.949,P<0.001)、异常昼-夜舒张压下降(OR=0.220,95%CI:0.065~0.806,P=0.022)为缺血性脑卒中患者脑白质病变严重程度的独立危险因素。结论在急性缺血性脑卒中人群中,大约37.8%的患者存在显著的脑白质病变;异常昼-夜舒张压变异是显著脑白质病变的独立危险因素。

Objective To investigate the correlation between cerebral white matter lesions(WML and blood pressure variability in patients with acute ischemic stroke.Methods Patients with acute ischemic stroke admitted to Beijing Tsinghua Changgung Hospital from January to November 2019 were retrospectively analyzed.The severity of WML was semi-quantitatively evaluated by Fazekas score and all patients were divided into marked WML group and mild WML group.Blood pressure variability was assessed by 24-hour ambulatory blood pressure monitoring.Univariate and multivariate analyses were performed on the general and specific variables related to blood pressure variability in the two groups,respectively,to evaluate the correlation between blood pressure variability and white matter lesions in patients with acute ischemic stroke.Results This study included 90 patients.26 cases were women,and the mean(±SD)age was 66.2±11.9 years.37.8%(34/90)of the patients had marked WML.Day-night systolic blood pressure dipping ratio was(3.4±8.0)%,and day-night diastolic blood pressure dipping ratio was(6.0±8.3)%.Abnormal day-night systolic blood pressure dipping and abnormal day-night diastolic blood pressure dipping were observed in 75.6%(68/90)and 70%(63/90)of patients,respectively.The age(OR=0.887,95% CI:0.829-0.949,P<0.001)and abnormal day-night diastolic pressure dipping(OR=0.220,95% CI:0.065-0.806,P=0.022)for patients with acute ischemic stroke were independent risk factors for the severity of cerebral white matter lesions.Conclusion In patients with acute ischemic stroke,about 37.8% of patientshave marked white matter lesions.Diurnal diastolic variation was found to be independent risk factor for severe white matter lesions in patients with acute ischemic stroke.