脑小血管病患者血压变异性与认知和情感障碍的关系

Relationships between blood pressure variability and cognitive and affective disorders in patients with cerebral small vessel disease

目的 探讨脑小血管病(CSVD)患者血压变异性(BPV)与认知和情感障碍的关系。方法 选择CSVD患者196例,根据蒙特利尔认知评估量表(MoCA)、汉密尔顿抑郁量表(HAMD-24)评分分别评估认知和情感障碍,其中认知障碍114例(认知障碍组)与无认知障碍82例(非认知障碍组)、情感障碍110例(情感障碍组)与无情感障碍86例(非情感障碍组)。采用便携式动态血压计监测24 h动态血压,记录日间收缩压标准差(DSBP-SD)、日间舒张压标准差(DDBP-SD)、夜间收缩压标准差(NSBP-SD)、夜间舒张压标准差(NDBP-SD)、24 h收缩压标准差(24 h SBP-SD)、24 h舒张压标准差(24 h DBP-SD)。分析CSVD患者BPV与认知和情感障碍的关系,以及CSVD患者发生认知或情感障碍的影响因素。结果 DSBP-SD、DDBP-SD、NSBP-SD、NDBP-SD、24 h SBP-SD、24 h DBP-SD等BPV指标,认知障碍组均显著高于非认知障碍组,情感障碍组均显著高于非情感障碍组(P均<0.05)。Pearson相关分析显示,CSVD患者DSBP-SD、DDBP-SD、NSBP-SD、NDBP-SD、24 h SBP-SD、24 h DBP-SD与MoCA评分均呈负相关关系,与HAMD评分均呈正相关关系(P均<0.05)。多因素Logistic回归分析显示,有高血压史、高血尿酸、高Hcy及NSBP-SD、24 h SBP-SD是CSVD患者发生认知障碍的独立危险因素,DSBP-SD、NSBP-SD、24 h SBP-SD是CSVD患者发生情感障碍的独立危险因素,而高文化程度则为CSVD患者发生认知或情感障碍的独立保护因素(P均<0.05)。结论 CSVD患者BPV与认知和情感障碍密切相关,其中NSBP-SD、24 h SBP-SD是CSVD患者发生认知障碍的独立危险因素,DSBP-SD、NSBP-SD、24 h SBP-SD是CSVD患者发生情感障碍的独立危险因素。

Objective To investigate the relationships between blood pressure variability(BPV) and cognitive and affective disorders in patients with cerebral small vessel disease(CSVD).Methods Totally 196 CSVD patients were selected.Cognitive and affective disorders were assessed by Montreal Cognitive Assessment scale(MoCA) and Hamilton Depression Scale(HAMD-24) in patients with CSVD,including 114 cognitive disorders(cognitive disorders group),82 non-cognitive disorders(non-cognitive disorders group),110 affective disorders(affective disorders group),and 86 nonaffective disorders(non-affective disorders group).The 24-hour ambulatory blood pressure data were monitored by portable ambulatory sphygmomanometer,including daytime systolic blood pressure-standard deviation(DSBP-SD),daytime diastolic blood pressure-standard deviation(DDBP-SD),nocturnal systolic blood pres sure-standard deviation(NSBP-SD),nocturnal diastolic blood pressure-standard deviation(NDBP-SD),24-hour systolic blood pressure-standard deviation(24 h SBP-SD),and 24-hour diastolic blood pressure-standard deviation(24 h DBP-SD).We analyzed the relationships between BPV and cognitive and affective disorders in patients with CSVD,and the influencing factors for cognitive or affective disorders in patients with CSVD.Results The BPV indexes such as DSBP-SD,DDBP-SD,NSBP-SD,NDBP-SD,24 h SBP-SD and 24 h DBP-SD in the cognitive disorders group were significantly higher than those in the non-cognitive disorder group,and those in the affective disorder group were significantly higher than those in the non-affective disorder group(all P<0.05),Pearson correlation analysis showed that DSBP-SD,DDBP-SD,NSBP-SD,NDBP-SD,24 h SBP-SD,24 h DBP-SD in patients with CSVD were negatively correlated with MoCA score,but were positively correlated with HAMD score(all P<0.05).Multivariate Logistic regression analysis showed that history of hypertension,high serum uric acid,high Hcy,NSBP-SD and 24 h SBP-SD were independent risk factors for cognitive disorders in patients with CSVD.DSBP-SD,NSBP-SD and 24 h SBP-SD were independent risk factors for affective disorders in patients with CSVD,while high education level was an independent protective factor for cognitive or affective disorders in patients with CSVD.Conclusions BPV in patients with CSVD is closely related to cognitive and affective disorders.NSBP-SD and 24 h SBP-SD are independent risk factors for cognitive disorders in patients with CSVD,while DSBP-SD,NSBP-SD and 24 h SBP-SD are independent risk factors for affective disorders in patients with CSVD.