老年人群血压变异性与无症状性未破裂颅内动脉瘤直径的相关性研究

Correlation between blood pressure variability and diameter of asymptomatic unruptured intracranial aneurysms in an elderly population

目的探讨老年患者血压变异性与无症状性未破裂颅内动脉瘤直径的关系。方法回顾性分析2021年1月1日至2022年12月31日于北京老年医院神经内科住院经脑血管造影确诊为无症状颅内未破裂动脉瘤(UIA),并完成24小时动态血压监测(24h ABPM)的老年患者83例。比较两组的一般资料与24h ABPM参数,采用Spearman相关性分析探讨24h ABPM参数与动脉瘤直径的相关性,并采用多元Logistic回归分析探讨老年颅内未破裂动脉瘤直径的独立影响因素。结果两组患者相比,目前吸烟、高血压病程、血清同型半胱氨酸(HCY)、血清超敏C反应蛋白(hs-CRP)水平之间存在统计学差异(P<0.05),其中大动脉瘤组患者目前吸烟比例更高,高血压病程更久,血清HCY、hs-CRP水平更高。大动脉瘤组24小时收缩压标准差(24hSSD)、24小时舒张压标准差(24hDSD)、夜间收缩压标准差(nSSD)、夜间舒张压标准差(nDSD)高于小动脉瘤组,两组相比差异有统计学意义(P<0.05),Spearman相关性分析显示24hSSD、24hDSD、nSSD、nDSD与动脉瘤直径呈正相关(P<0.05)。二元Logistic回归分析显示目前吸烟、高血压病程、24hDSD是动脉瘤直径大小的影响因素。结论大动脉瘤的老年患者高血压病程更长、血压变异性(BPV)更高。舒张压标准差对预测动脉瘤增长有一定的意义。

Objective To investigate the relationship between blood pressure variability and diameter of asymptomatic unruptured intracranial aneurysms in elderly patients.Methods 83 elderly patients who were diagnosed with asymptomatic intracranial unruptured aneurysm(UIA)by cerebral angiography and completed 24-hour ambulatory blood pressure monitoring(24h ABPM)in the department of Neurology of Beijing Geriatrics Hospital from 1 January 2021 to 31 December 2022 were retrospectively enrolled,and were divided into the small aneurysm group(diameter<7 mm,63 cases)and the large aneurysm group(diameter≥7mm,20 cases),according to the size of the diameter.The general data and 24h ABPM parameters of the two groups were compared,and spearman correlation analysis was used to investigate the correlation between 24h ABPM parameters and aneurysm diameter,and multivariate logistic regression analysis was used to investigate the independent influences on the diameter of UIA in the elderly.Results There were statistically significant differences(P<0.05)in current smoking,duration of hypertension,serum homocysteine(HCY),and serum hypersensitive C-reactive protein(hs-CRP)levels between the two groups.The large aneurysm group has a higher proportion of patients in being current smokers,a longer duration of hypertension,and higher levels of serum HCY and hs-CRP.The 24hSSD,24hDSD,nSSD,and nDSD were higher in the large aneurysm group than those in the small aneurysm group,the difference was statistically significant(P<0.05),and spearman's correlation analysis showed a positive correlation between the 24hSSD,24hDSD,nSSD,nDSD and the diameter of the aneurysm(P<0.05).Binary logistic regression analysis showed that current smoking,duration of hypertension,and 24hDSD were the influencing factors of aneurysm diameter size.Conclusion Patients with large aneurysms have a longer hypertension duration and higher blood pressure variability(BPV).Diastolic blood pressure standard deviation is relevant in predicting aneurysm growth.