目的: 观察至高血压门诊就诊的未接受降压治疗的人群中,无症状性颅内动脉狭窄的患病情况,并分析其影响因素。方法: 选择2009年至2013年瑞金医院高血压科动态血压监测门诊就诊的未接受降压治疗的患者作为研究对象,采用经颅多普勒超声检测其双侧大脑前、中、后动脉和椎动脉的狭窄情况,采用t检验及卡方检验比较狭窄组与非狭窄组间的临床特征差异,并采用多元Logistic回归分析颅内动脉狭窄的影响因素。结果: 1 130例患者的平均年龄为51岁,男性占49%,其中高血压、糖尿病患者分别占63% 及5.3%。颅内动脉狭窄的患病率为7.4%（84例）,且狭窄多位于大脑前动脉（45例）及大脑中动脉（44例）,而大脑后动脉（16例）及椎动脉（7例）狭窄较少。颅内动脉狭窄组的24 h收缩压显著高于非狭窄组（132 mmHg比126 mmHg, P<0.001）,2组间的其余临床特征差异无统计学意义（P≥0.10）。多元Logistic回归分析显示,女性的颅内动脉狭窄患病风险比男性增加72%（95%CI为6%~179%, P=0.026）,且患者的24 h收缩压每增加10 mmHg,颅内动脉狭窄的患病风险增加56% (95%CI为29%~88%,P<0.001)。不同时段（白天、夜间、清晨时段）的收缩压增高均与颅内动脉狭窄患病风险增加有关,收缩压每增加10 mmHg,颅内动脉狭窄患病风险增加34%~47%（P均<0.001）。结论: 在我国高血压门诊未行降压治疗的人群中有较高的无症状性颅内动脉狭窄患病率,而收缩压升高是其重要的影响因素。

Objectives: To investigate the prevalence and determinants of asymptomatic intracranial artery stenosis in untreated patients from hypertension outpatient clinic. Methods: Outpatients having not treated with antihypertensive medi-cation for Ambulatory Blood Pressure Monitoring at Department of Hypertension, Ruijin Hospital from the year of 2009 to 2013 were recruited. Transcranial Doppler ultrasonography was used to assess the stenosis at the bilateral anterior, middle and posterior cerebral arteries and vertebral arteries. T test and Chi square test were used to compare the difference in clinical features between patients with stenosis and those without. Multiple logistic regression analysis was used to analyze the determinants of intracranial arterial stenosis. Results: A total of 1 130 patients with average age of 51 years were enrolled, including 49% males, 63% hypertensives and 5.3% diabetic patients. The prevalence of intracranial arterial stenosis was 7.4% (84 cases). The stenosis located mainly at anterior (45 cases) and middle (44 cases) cerebral arteries, less frequently at posterior (16 cases) or vertebral (7 cases) arteries. No differences in clinic characteristics were found between patients with and without stenosis, except that 24-h systolic blood pressure was significantly higher in patients with intracranial arterial stenosis (132 vs 126 mmHg, P<0.001). Multivariate logistic regression analyses showed that women had higher risk of intracranial arterial stenosis than men by 72% (95% CI, 6%-179%, P=0.026). For every 10 mmHg increase in 24-h systolic blood pressure, the risk of intracranial artery stenosis increased by 56% (29%-88%, P<0.001). Irrespective of the time of measuring (daytime, nighttime, morning), increase of systolic blood pressure was associated with increased risk of intracranial arterial stenosis, and for every 10 mmHg increase, risk of intracranial artery stenosis increased by 34%-47% (P all <0.001). Conclusions: Asymptomatic intracranial artery stenosis is moderately prevalent in untreated Chinese patients at the hypertension clinic, of which systolic blood pressure is an important determinant.