高血压患者脑血管周围间隙扩大和脑腔隙灶相关影响因素

doi:10.16150/j.1671-2870.2021.04.008

摘要/Abstract

摘要：

目的：探讨高血压患者出现脑血管周围间隙扩大（enlarged perivascular spaces,EPVS）及脑腔隙灶的相关影响因素,为防治脑小血管病提供依据。 方法：回顾性纳入1 070例既往无卒中病史的原发性高血压患者,完成脑部MRI扫描和动态血压监测后,根据其MRI图像上有无EPVS和腔隙灶,分为对照组、EPVS组、腔隙灶组,比较3组间的基线资料差异。在EPVS组、腔隙灶组与对照组之间进行单因素和多因素logistic回归分析,观察导致高血压患者出现脑EPVS、脑腔隙灶的影响因素。 结果：EPVS组、腔隙灶组与对照组之间的年龄、性别、吸烟史、糖尿病史、抗血小板药和他汀类药物使用情况、高血压病程、夜间血压下降幅度、平均收缩压、是否存在颈动脉斑块及胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、尿素氮、肌酐、同型半胱氨酸水平等差异均具有统计学意义。平均收缩压增高、年龄增大是高血压患者出现EPVS的独立危险因素,而夜间血压下降幅度大及使用抗血小板药、他汀类药物是其独立保护因素;平均收缩压增高、年龄增大、有吸烟史、糖尿病史是高血压患者出现腔隙灶的独立危险因素,而夜间血压下降幅度大及使用抗血小板药、他汀类药物是其独立保护因素。 结论：在高血压患者中,平均收缩压增高和夜间血压下降幅度降低是其发生脑EPVS和腔隙灶的独立危险因素,高血压患者除了需要关注控制平均收缩压水平等因素外,还应采取时辰疗法,采用调整给药时间,恢复正常的夜间血压下降幅度。

关键词: 脑血管周围间隙扩大, 脑腔隙灶, 夜间血压下降幅度, 时辰疗法, 高血压

Abstract:

Objective: To explore the related factors of enlarged perivascular spaces (EPVS) and lacunes in the patients with hypertension, and to provide a basis for the prevention and treatment of cerebral small vessel disease. Methods: A total of 1 070 patients with essential hypertension without stroke history were enrolled, and the data was analyzed retrospectively. All patients received MRI scanning and ambulatory blood pressure monitoring. According to MRI images, they were divided into normal control, EPVS and lacunes groups, respectively. Univariate and multivariate logistic regression were performed among three groups to determine the factors related to EPVS and lacunes. Results: The indexes including age, gender, smoking, diabetes history, antiplatelet drugs, statins, hypertension duration, nocturnal blood pressure dip degree, mean systolic blood pressure, cholesterol, triglyceride, high-density lipoprotein, low density lipoprotein, urea nitrogen, creatinine, homocysteine and carotid plaque were significantly different among EPVS, lacunes and controls groups. Mean high systolic blood pressure and age were independent risk factors for EPVS, while the dipping degree of blood pressure, antiplatelet medicines and statins were independent protective factors for it. High mean systolic blood pressure, old age, smoking, and diabetes were independent risk factors for lacunes, while the dipping degree of nocturnal blood pressure, antiplatelet medicines and statins were independent protective factors for lacunes. Conclusions: For the patients with hypertension, the increase of mean systolic blood pressure and the decrease of nocturnal blood pressure dipping are the risk factors for EPVS and lacunes. Besides controlling mean systolic blood pressure level, the patients with hypertension should also receive chronotherapy to restore the normal nocturnal blood pressure dipping through changing the time of taking medicine.

Key words: Enlarged perivascular spaces, Lacunes, Nocturnal blood pressure dip degree, Chronotherapy, Hypertension

中图分类号:

R541.7

杨扬, 吴琴咪, 冯玉兰, 张蓓, 傅毅. 高血压患者脑血管周围间隙扩大和脑腔隙灶相关影响因素[J]. 诊断学理论与实践, 2021, 20(04): 372-377.

YANG Yang, WU Qinmi, FENG Yulan, ZHANG Bei, FU Yi. Factors related to enlarged perivascular spaces and lacunes in patients with hypertension[J]. Journal of Diagnostics Concepts & Practice, 2021, 20(04): 372-377.

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变量	对照组(n=317)	EPVS组(n=395)	腔隙灶组(n=358)	P值
年龄(岁,$\bar{x}±s$)	57±11	69±12	66±13	<0.001
男性	135(42.6)	190(48.1)	187(52.2)	0.002
吸烟	48(15.1)	75(19.0)	84(23.5)	0.006
糖尿病	46(14.5)	143(36.2)	120(33.5)	<0.001
抗血小板药	55(17.4)	24(6.1)	21(6.2)	<0.001
他汀类药物	63(19.9)	36(9.1)	48(13.4)	0.001
病程(年,$\bar{x}±s$)	7.5±7.3	13.8±10.5	12.9±10.9	<0.001
夜间血压下降幅度(%, M, IQR)	8.4(1.2~15.7)	5.2(-6.1 ~15.3)	5.7(-7.0~15.6)	<0.001
平均收缩压(mmHg,$\bar{x}±s$)	127.6±14.7	135.8±17.6	132.1±16.7	<0.001
胆固醇(mmol/L,$\bar{x}±s$)	4.6±1.1	4.4±1.2	4.4±1.1	0.007
甘油三酯(mmol/L, M, IQR)	1.4(1.0~1.9)	1.5(1.1~2.2)	1.6(1.2~2.3)	0.007
HDL(mmol/L,$\bar{x}±s$)	1.3±0.8	1.1±0.3	1.2±0.4	<0.001
LDL(mmol/L,$\bar{x}±s$)	2.9±0.9	2.8±0.9	2.7±0.9	<0.001
尿素氮(mmol/L, M, IQR)	5.1(4.2~6.5)	5.5(4.9~6.9)	5.2(4.4~6.2)	0.013
肌酐(mmol/L, M, IQR)	62.0(51.0~77.8)	72.0(59.0~88.0)	73.0(59.0~84.0)	<0.001
同型半胱氨酸(μmol/L, M, IQR)	10.5(8.8~13.9)	12.2(10.0~15.6)	11.8(10.1~14.8)	<0.001
颈动脉斑块	74(23.4)	262(66.3)	193(53.9)	<0.001

因素	EPVS组与对照组		腔隙灶组与对照组
因素	OR值	P值	OR值	P值
年龄增大	1.051	<0.001	1.061	<0.001
男性	1.250	0.142	1.474	0.012
吸烟	1.090	<0.001	1.551	0.001
糖尿病	3.343	<0.001	2.970	<0.001
使用抗血小板药	0.316	<0.001	0.310	<0.001
使用他汀类药物	0.404	<0.001	0.624	0.024
夜间血压下降幅度大	0.109	<0.001	0.111	<0.001
平均收缩压	1.028	<0.001	1.014	0.004
胆固醇	0.880	0.057	0.848	0.023
甘油三酯	1.067	0.205	1.113	0.057
高密度脂蛋白	0.437	<0.001	0.666	0.019
尿素氮	0.967	<0.001	0.950	<0.001
肌酐	1.013	<0.001	1.011	<0.001
同型半胱氨酸	1.075	0.006	1.056	0.030
有颈动脉斑块	6.453	<0.001	3.837	<0.001

因素	OR值	95%置信区间	P值
夜间血压下降幅度大	0.098	0.034~0.287	0.030
平均收缩压	1.024	1.010~1.034	0.016
年龄增大	1.070	1.059~1.082	<0.001
使用抗血小板药	0.297	0.183~0.482	0.012
使用他汀类药物	0.261	0.173~0.394	0.001

因素	OR值	95%置信区间	P值
夜间血压下降幅度大	0.155	0.075~0.321	<0.001
平均收缩压	1.014	1.008~1.020	0.021
年龄增大	1.070	1.061~1.080	<0.001
使用抗血小板药	0.228	0.161~0.324	<0.001
使用他汀类药物	0.571	0.427~0.763	0.053
吸烟	3.561	2.773~4.572	<0.001
糖尿病	2.385	1.902~2.989	<0.001