H型高血压合并ACI病人血压变异性、脉压指数与认知功能的关系

Relationship between Blood Pressure Variability,Pulse Pressure Index and Cognitive Function in Patients with H-type Hypertension Complicated with ACI

目的:分析H型高血压合并急性脑梗死(ACI)病人血压变异性(HPV)、脉压指数(PPI)与认知功能的关系。方法:选取2020年1月—2022年1月于我院就诊的120例H型高血压病人,根据是否合并ACI将48例合并ACI的病人作为合并组,将72例未合并ACI的病人作为未合并组;另选取同期我院体检中心健康体检者60名作为对照组。采用蒙特利尔认知功能量表(MoCA)评估病人认知功能;比较3组血清同型半胱氨酸(Hcy)、24 h收缩压变异系数(24 hSCV)、24 h舒张压变异系数(24 hDCV)、PPI、MoCA评分。比较不同认知功能障碍ACI病人血清Hcy、24 hSCV、24 hDCV、PPI变化;采用Pearson法分析血清Hcy、24 hSCV、24 hDCV、PPI与MoCA评分的相关性,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),分析血清Hcy、24 hSCV、24 hDCV、PPI、MoCA评分对认知功能障碍的预测价值。结果:合并组血清Hcy、24 hSCV、24 hDCV、PPI均高于未合并组、对照组(P<0.05);未合并组血清Hcy、24 hSCV、24 hDCV、PPI均高于对照组(P<0.05)。合并组MoCA各维度评分及总分均低于未合并组、对照组(P<0.05);未合并组定向力、抽象思维、注意力及总分均低于对照组(P<0.05)。认知功能障碍组血清Hcy、24 hSCV、24 hDCV、PPI均高于无认知功能障碍组,差异均有统计学意义(P<0.05)。血清Hcy、24 hSCV、24 hDCV、PPI与MoCA评分均呈正相关(P<0.001)。ROC曲线结果显示:血清Hcy、24 hSCV、24 hDCV、PPI、MoCA评分联合预测认知功能障碍的AUC是0.792,均高于单一指标的预测价值(P<0.05)。结论:H型高血压合并ACI病人血清Hcy、24 hSCV、24 hDCV、PPI均较高,与认知功能有关,血清Hcy、24 hSCV、24 hDCV、PPI及MoCA评分联合检测可提高对认知功能障碍的预测价值。

Objective:To analyze the relationship between blood pressure variability(HPV),pulse pressure index(PPI)and cognitive function in patients with H-type hypertension complicated with acute cerebral infarction(ACI).Methods:One hundred and twenty patients with H-type hypertension were selected.According to whether the patients were comorbid with ACI or not,48 patients with comorbid ACI were selected as the comorbid group,72 patients without comorbid ACI were selected as the non-comorbid group,and 60 healthy check-ups in our medical check-up centre during the same period were selected as the control group.The cognitive function of the patients was assessed by the Montreal Cognitive Assessment(MoCA).Serum homocysteine(Hcy),24 h systolic blood pressure variation coefficient(24 hSCV),24 h diastolic blood pressure variation coefficient(24 hDCV),PPI and MoCA scores were compared among the 3 groups.The serum Hcy,24 hSCV,24 hDCV and PPI in ACI patients with different cognitive dysfunction were compared.Pearson method was used to analyze the correlation between serum Hcy,24 hSCV,24 hDCV,PPI and MoCA score.Receiver operating characteristic(ROC)curve were plotted,the area under the ROC curve(AUC)was calculated,and the predictive value of serum Hcy,24 hSCV,24 hDCV,PPI,and MoCA scores for cognitive dysfunction was analyzed.Results:Serum Hcy,24 hSCV,24 hDCV and PPI in the comorbid group were more than those in the non-comorbid group and control group(P<0.05).Serum Hcy,24 hSCV,24 hDCV and PPI in the non-combined group were more than those in the control group(P<0.05).MoCA different dimension scores and total scores in the increased group were less than those in the non-combined group and the control group(P<0.05).The orientation,abstract thinking,attention and total score of the non-combined group were lower than those of the control group(P<0.05).Serum Hcy,24 hSCV,24 hDCV and PPI in the cognitive dysfunction group were more than those in the non-cognitive dysfunction group,and the difference was statistically significant(P<0.05).Serum Hcy,24 hSCV,24 hDCV and PPI were positively correlated with MoCA score(P<0.05).The results of ROC curve showed that the AUC of combined detection with serum Hcy,24 hSCV,24 hDCV,PPI,and MoCA score for predicting cognitive dysfunction was 0.792,which was higher than the predictive value of the single index(P<0.05).Conclusion:Higher serum Hcy,24 hSCV,24 hDCV,and PPI in patients with H-type hypertension complicated with ACI were related to cognitive function,and combined detection of of serum Hcy,24 hSCV,24 hDCV,PPI,and MoCA scores might improve the predictive value of cognitive dysfunction.