急性腔隙性卒中患者血压的变异性及节律与脑白质高信号的相关性研究

Correlation of blood pressure variability and rhythm with white matter hyperintensity in patients with acute lacunar stroke

目的探索急性腔隙性卒中患者脑白质高信号与血压变异性及血压节律的关联。方法回顾性纳入2017年1月-2019年1月于武汉市中西结合医院神经内科收治的急性腔隙性卒中患者156例,根据患者的头部MRI检查结果,采用Fazekas评分法将入组患者分为轻度白质病变组(n=76)和中重度白质病变组(n=80)。收集2组患者的一般信息、血管危险因素、实验室指标和其他检查结果,通过24 h ABPM获取血压变异性指标和血压节律,比较和分析影响急性腔隙性卒中患者WMH的相关因素。结果中重度WMH组的既往卒中史(P=0.005)、急性腔隙性梗死灶数目(P=0.021)、颈动脉斑块等级积分(P=0.041)均高于轻度WMH组;中重度WMH组的全天SBP-SD(P=0.01)、日间SBP-SD(P=0.004)、日间SBP-CV(P=0.018)、日间DBP-SD(P=0.028)均明显升高;在两组血压昼夜节律比较中,中重度WMH组反杓型血压节律的比例显著升高(P=0.03),轻度WMH组杓型血压比例更高(P=0.045)。多因素Logistic回归分析发现,急性腔梗病灶数目(OR=2.114,95%CI 1.143~3.910,P=0.017)及反杓型血压(OR=0.389,95%CI 0.166~0.912,P=0.030)是急性腔隙性卒中患者脑白质高信号的独立危险因素,并且在校正年龄、性别、血管危险因素后仍具有统计学差异(P<0.05)。结论急性腔隙性卒中患者的WMH与血压变异性(尤其是收缩压变异性)密切相关,反杓型血压节律是影响WMH的独立危险因素。

Objective To investigate the relationship between white matter hyperintensity and blood pressure variability and blood pressure rhythm in patients with acute lacunar stroke.Methods A total of 156 patients with acute lacunar stroke admitted to the Department of Neurology,Wuhan Hospital of Traditional Chinese and Western Medicine from January 2017 to January 2019 were retrospectively enrolled,according to the results of cranial MRI examination,the enrolled patients were divided into mild white matter lesions group(n=76)and moderate and severe white matter lesions group(n=80)by Fazekas score.General information about vascular risk factors laboratory indicators and other findings were collected for both groups,the blood pressure variability and circadian rhythm were measured by 24 h ABPM,compare and analyze the related factors affecting WMH in patients with acute lacunar stroke.Results The history of prior stroke(P=0.005),the number of acute lacunar infarction(P=0.021),and the grade score of carotid plaque(P=0.041)in moderate and severe WMH group were higher than those in mild WMH group;The total day SBP-SD(P=0.01)daytime SBP-SD(P=0.004)daytime SBP-CV(P=0.018)daytime DBP-SD(P=0.028)were significantly increased in the moderate and severe WMH group;In the comparison of circadian rhythm of blood pressure between the two groups,the riser pattern circadian rhythm in moderate and severe WMH group was significantly higher(P=0.03),and the arytenoid circadian rhythm in mild WMH group was higher(P=0.045).The multivariate Logistic regression analysis showed that the number of acute infarct lesions(OR=2.114,95%CI 1.143-3.910,P=0.017)and riser pattern circadian rhythm(OR=0.389,95%CI 0.166-0.912,P=0.030)were independent risk factors for white matter hyperintensity in patients with acute lacunar stroke after adjusting for age,sex,and gender vascular risk factors(P<0.05).Conclusion WMH in patients with acute lacunar stroke is closely related to blood pressure variability(especially systolic blood pressure variability),and riser pattern circadian rhythm is an independent risk factor for WMH.