中老年高血压患者血压昼夜节律波动类型对脑微出血的影响

Cerebral microbleed are associated with the circadian rhythm of blood pressure in middle-aged and elderlyhypertensive patients

目的探讨中老年高血压患者血压昼夜节律波动类型与脑微出血(CMB)的关系。方法选取有高血压病的中老年患者,通过24 h动态血压仪监测血压及颅脑磁敏感加权成像(SWI)序列检测脑微出血,对年龄分组后,比较脑微出血患者的危险因素,并通过Logistic回归分析不同血压昼夜节律波动类型和CMB、CMB发生位置的关系。结果在中年高血压患者中,34%的患者可见CMB,血压昼夜波动类型和CMB的发生差异无统计学意义(P>0.05);在老年高血压患者中,52%的患者存在CMB,经多因素分析后发现血压昼夜节律波动类型和CMB的发生有关,并且非杓型高血压患者比杓型高血压患者发生脑微出血的风险更大(OR=3.959,P=0.032),进一步对CMB的发生部位进行分析,发现和杓型高血压相比,非杓型高血压和深部CMB的发生有关(OR=6.201,P=0.007)。结论血压昼夜节律异常可能是老年高血压患者发生CMB的危险因素。

Objective To discuss the relationship between circadian rhythm of blood pressure and cerebral microbleed(CMB)in middle-aged and elderly hypertensive patients.Methods The CMB data of the middle aged and elderly subjects with both hypertension and monitored blood pressure were detected by 24-hour ambulatory blood pressure monitoring(ABPM)and assessed by susceptibilit weighted imaging(SWI).The risk factors were compared between CMB(+)vs.(-)groups after grouping based on the age,then the correlation between blood pressure circadian rhythm and CMB as well as the location of CMB were analyzed by logistic regression.Results 34%of the subjects with hypertension had CMB and the circadian rhythm of blood pressure associated with the presence of CMB had no statistical significance in middle-aged hypertensive subjects(P>0.05).There were 52%subjects with hypertension had CMB,and blood pressure circadian rhythm were associated with the occurrence of CMB on multiple factors analysis in elderly subjects with hypertension,and the non-dipper hypertensive subjects with CMB(OR=3.959,P=0.032)had higher risk than the dipper hypertensive subjects.According to the location of CMB,blood pressure circadian rhythm was associated with the occurrence of deep CMB on multiple factors analysis,and the non-dipper hypertensive subjects with deep CMB(OR=6.201,P=0.007)was higher risk than dipper hypertensive subjects.Conclusion The circadian rhythm type of blood pressure may be the risk factor of the occurrence of CMB.