脑小血管病患者血压变异度与非痴呆型认知功能障碍的相关性

Correlation between blood pressure variability and non-dementia cognitive dysfunction in patients with small cerebral vascular disease

目的探究脑小血管病(Small vessel disease,SVD)患者血压变异度(Blood pressure variability,BPV)与非痴呆型认知功能障碍(Vascular cognitive impairment-no dementia,VCIND)的相关性。方法采用病例-对照研究设计回顾性连续收集2021年1月-2023年2月于本院就诊的SVD合并VCIND的46例患者为观察组,并按照1∶4的比例纳入同时期入院的184例SVD未合并VCIND的患者为对照组;比较2组患者的临床资料及BPV参数,采用多因素Logistic回归分析SVD患者发生VCIND的影响因素;构建相应预测模型并进行评价;采用LOWESS方法分析连续变量二维曲线关系。结果年龄、高血压病、高敏C反应蛋白(Hypersensitive C-reactive protein,hs-CRP)、血浆同型半胱氨酸(Homocysteine,Hcy)、日间平均收缩压(Daytime mean systolic blood pressure,dmSBP)、夜间平均收缩压(Nighttime mean systolic blood pressure,nmSBP)、日间收缩压变异系数(Daytime systolic blood pressure coefficient of variation,dSBPCV)是SVD患者发生VCIND的危险因素(P<0.05)。基于上述数据建立的预测模型:Logit(P)=-3.540+0.856(年龄)+0.092(高血压病史)+0.617(hs-CRP)+0.387(Hcy)+0.707(dmSBP)+1.016(nmSBP)+0.931(dSBPCV);经检验,P=0.85时约登指数最高,预测效果相对最好。LOWESS分析显示dmSBP,nmSBP,dSBPCV与患者蒙特利尔认知评估量表(Montreal cognitive assessment scale,MoCA)总分均具有一定的非线性关系。结论SVD患者BPV参数与认知功能障碍密切相关,其中dmSBP,nmSBP,dSBPCV是SVD患者发生VCIND的危险因素。

Objective To explore the correlation between blood pressure variability(BPV)and vascular cognitive impairment-no dementia(VCIND)in patients with small vessel disease(SVD).Methods A casecontrol study design was used to retrospectively and continuously review 46 patients with SVD and VCIND admitted to our hospital between January 2021 and February 2023 as the observation group,and 184 patients with SVD and no VCIND admitted to our hospital during the same period were included as the control group at a ratio of 1∶4.The clinical data and BPV parameters of the two groups were compared,and the influencing factors of VCIND in SVD patients were analyzed via multivariate logistic regression.The corresponding prediction model was constructed and evaluated.The LOWESS method was used to analyze the two-dimensional curve relationships of continuous variables.Results Age,hypertension,high-sensitivity C-reactive protein(hs-CRP),plasma homocysteine(Hcy),daytime mean systolic blood pressure(dmSBP),nighttime mean systolic blood pressure(nmSBP)and the daytime systolic blood pressure coefficient of variation(dSBPCV)were risk factors for VCIND in SVD patients(P<0.05).The prediction model based on the above results was as follows:Logit(P)=-3.540+0.856(age)+0.092(hypertension)+0.617(hs-CRP)+0.387(Hcy)+0.707(dmSBP)+1.016(nmSBP)+0.931(dSBPCV).After testing,the Jorden index was the highest when P=0.85,and the prediction effect was the best.LOWESS analysis revealed that dmSBP,nmSBP,and dSBPCV had nonlinear relationships with the total score of the Montreal Cognitive Assessment Scale(MoCA).Conclusion BPV parameters are closely related to cognitive dysfunction in SVD patients,among which dmSBP,nmSBP,and dSBPCV are risk factors for VCIND in SVD patients.