血压变异致老年脑梗死患者颈动脉狭窄进展及预后的影响

Effects of blood pressure variability on the progression and prognosis of carotid artery stenosis in elderly patients with cerebral infarction

目的探讨血压变异致老年脑梗死患者颈动脉狭窄进展及预后的影响。方法选取2019年5月至2022年5月收治的98例老年脑梗死患者作为研究对象,老年脑梗死患者按颈动脉狭窄程度分为四组,比较各组血压变异性(blood pressure variability,BPV)相关参数值,分析BPV与颈动脉狭窄程度的关系。分析血管性事件发生的危险因素,并评估BPV对血管性事件的预测效能。结果颈动脉狭窄程度越高患者,其BPV参数值越高,血压夜间下降率越低(P<0.05)。重度狭窄组总非杓型占比高于中度、轻度狭窄组及无狭窄组(P<0.05)。Spearman相关性分析显示:BPV参数值均与颈动脉狭窄程度呈正相关,血压夜间下降率与颈动脉狭窄程度呈负相关(均P<0.05)。多因素logistic回归分析显示:BPV参数值升高均为老年脑梗死患者血管性事件发生的的危险因素(P<0.05)。受试者工作特征曲线(ROC)分析显示:BPV参数中dSSD预测脑梗死患者血管性事件发生的效能最高。结论BPV显著影响老年脑梗死患者颈动脉狭窄的进展和预后。

Objective To explore the effect of blood pressure variability(BPV)on the progression and prognosis of carotid artery stenosis in elderly patients with cerebral infarction.Methods A total of 98 elderly patients with cerebral infarction admitted from May 2019 to May 2022 were selected as the observation group,and 100 healthy people with physical examination during the same period were enrolled as the control group.According to the degree of carotid artery stenosis,the elderly patients with cerebral infarction were divided into four groups.The blood pressure variability parameters in each group were compared,and the relationship between BPV and the degree of carotid artery stenosis was analyzed.The risk factors of vascular events were analyzed and the predictive efficiency of BPV on vascular events was evaluated.Results The BPV parameter values in the observation group were higher than those in the control group(P<0.05),while the nocturnal decline rate of blood pressure was lower than that in the control group(P<0.05).The higher the degree of carotid artery stenosis,the higher the BPV parameter value and the lower the nocturnal decline rate of blood pressure(P<0.05).The proportion of total non-dipper type in the severe stenosis group was higher than that in the moderate stenosis group,mild stenosis group and non-stenosis group(P<0.05).Spearman correlation analysis showed that the BPV parameter values were positively correlated with the degree of carotid artery stenosis,and the nocturnal decline rate of blood pressure was negatively correlated with the degree of carotid artery stenosis(all P<0.05).Multivariate logistic regression analysis showed that the increases of BPV parameter values were all risk factors for vascular events in elderly patients with cerebral infarction(P<0.05).Receiver operating characteristic(ROC)curve analysis revealed that among the BPV parameters,dSSD had the highest efficiency in predicting the occurrence of vascular events in elderly patients with cerebral infarction.Conclusion BPV significantly affects the progression and prognosis of carotid artery stenosis in elderly patients with cerebral infarction.