血压变异干预策略对高血压脑白质疏松、预后卒中及认知的影响

Effect of BPV intervention strategy on hypertensive leukoaraiosis and its prognosis of stroke and cognition

摘要:

目的 探讨血压变异性（BPV）干预策略对高血压脑白质疏松（LA）、预后卒中及认知的影响。方法 前瞻性研究2013年1月—2016年12月郑州人民医院神经内科就诊并最终纳入统计的高血压患者269例。BPV以血压标准差（SD）、变异系数（CV）表示。其中无或轻度LA组定义为对照组，中重度LA组定义为病变组。采用多因素Logistic回归分析BPV与LA的关系。入院后给予不同类别降压药物，同时，采用简明精神量表（MMSE）进行认知功能状态评分。1年后再次复查患者BPV及LA程度。分析不同降压药物对BPV、LA及1年内卒中事件和认知功能变化的影响。结果 ①病变组收缩压CV、收缩压SD、杓型分型与对照组比较，差异有统计学意义（P?<0.05）。②较高收缩压SD、非杓型特点为LA的危险因素。[OlR=2.168（95% CI：1.120，4.195），P?=0.022；OlR=2.764（95% CI：1.405，5.437），P?=0.003]。③氨氯地平组用药后中重度LA比例、卒中事件发生率较依那普利及美托洛尔组降低（P?<0.05）；用药后氨氯地平、依那普利及美托洛尔组的SD分别为（13.756±2.919）、（14.919±3.037）和（15.433±2.962）（P?<0.05）；用药后氨氯地平、依那普利及美托洛尔组的MMSE评分分别为（27.484±2.267）、（26.575±2.488）和（26.032±3.113）（P?<0.05）。结论 收缩压SD及非杓型特点是预测LA较好且简易的指标，钙离子拮抗剂或长效降压药物可降低血压变异性，是预防LA、减少卒中及认知功能减退的有效措施。

Abstract:

Objective To explore the effect of BPV intervention strategy on hypertensive leukoaraiosis (LA) and its prognosis of stroke and cognition. Methods A prospective study of 269 patients with hypertension from Zhengzhou People's Hospital from January 2013 to December 2016 was included. BPV was expressed as a standard deviation of blood pressure (SD) and a coefficient of variation (CV). Among them, no or mild LA group was defined as the control group, and moderate to severe LA group was defined as the disease group. Multivariate logistic regression was used to analyze the relationship between BPV and LA. Different types of antihypertensive drugs were given after admission, and cognitive function status scores were performed using the Simple Mental Scale (MMSE). After 1 year, the patient's BPV and LA degree were reviewed again. To analyze the effects of different antihypertensive drugs on BPV, LA and stroke and cognitive function changes within 1 year. Results The systolic blood pressure CV, systolic blood pressure SD, and sputum type were significantly different from the control group (P?