无症状腔隙性脑梗死患者脑微出血与血压变异性的关系

Relationship between cerebral microbleeds and blood pressure variability in patients with asymptomatic lacunar infarction

目的探讨无症状腔隙性脑梗死(LI)患者脑微出血(CMBs)与血压变异性(BPV)的关系。方法选取无症状LI患者为研究对象。将磁敏感成像(SWI)显示CMBs的50例患者设为研究组,另选取无CMBs的50例患者设为对照组。收集2组患者临床资料,应用动态血压监测(ABPM)收集BPV相关参数,并对节律进行分型。结果研究组24 h平均收缩压(24 h SBP)、夜间平均收缩压(NSBP)、夜间平均舒张压(NDBP)、24 h收缩压变异系数(24 h SBP-CV)、24 h舒张压变异系数(24 h DBP-CV)均高于对照组,差异有统计学意义(P<0.05或P<0.01)。研究组中异常节律者44例(88.00%),对照组中异常节律者35例(70.00%),差异有统计学意义(P<0.05)。研究组非杓型、反杓型、超杓型异常节律患者CMBs发生率依次为29.55%(13/44)、43.18%(19/44)、27.27%(12/44),对照组中依次为42.86%(15/35)、17.14%(6/35)、40.00%(14/35),差异有统计学意义(P=0.047)。Spearman分析结果显示,24 h DBP-CV、24 h SBP-CV与CMBs数量分级呈正相关(r=0.561、0.435,P<0.01)。结论血压均值水平及BPV均与CMBs相关,血压均值水平越高、BPV越大,则CMBs的发生率越高;异常节律是CMBs的重要危险因素;变异系数与CMBs严重程度呈正相关。

Objective To investigate the relationship between cerebral microbleeds(CMBs)and blood pressure variability(BPV)in patients with asymptomatic lacunar infarction(LI).Methods The asymptomatic LI patients were selected as the research objects.A total of 50 patients with CMBs displayed by magnetic sensitivity imaging(SWI)were designed as study group,and 50 patients without CMBs were selected as control group.The clinical materials were collected in both groups,the parameters related to BPV were collected by ambulatory blood pressure monitoring(ABPM),and the rhythm was classified.Results The 24 h mean systolic blood pressure(24 h SBP),nighttime mean systolic blood pressure(NSBP),nighttime mean diastolic blood pressure(NDBP),24 h coefficient of variation of systolic blood pressure(24 h SBP-CV)and 24 h coefficient of variation of diastolic blood pressure(24 h DBP-CV)in the study group were significantly higher than those in the control group(P<0.05 or P<0.01).There were 44 cases(88.00%)with abnormal rhythm in the study group and 35 cases(70.00%)with abnormal rhythm in the control group,and the difference was statistically significant(P<0.05).The incidence rates of CMBs in patients with abnormal rhythms of non-dipper type,anti-dipper type and super-dipper type in the study group were 29.55%(13/44),43.18%(19/44)and 27.27%(12/44)respectively,which showed significant differences when compared to 42.86%(15/35),17.14%(6/35)and 40.00%(14/35)respectively in the control group(P=0.047).Spearman analysis showed that 24 h DBP-CV and 24 h SBP-CV were positively correlated with the grading of CMBs number(r=0.561,0.435,P<0.01).Conclusion Both mean blood pressure and BPV are correlated with CMBs,and the higher the mean blood pressure and BPV are,the higher the incidence of CMBs is;abnormal rhythm is an important risk factor for CMBs;CV is positively correlated with the severity of CMBs.