原发性高血压患者血压变异性及危险因素与缺血性脑白质疏松症的关系

The Relationship between Blood Pressure Variability, Risk Factors and Ischemic Leukoaraiosis in Patients with Primary Hy-pertension

摘要: 目的：探寻原发性高血压患者血压变异性及危险因素与缺血性脑白质疏松症(leukoaraiosis, LA)的关系。方法：以202例原发性高血压病人作为研究对象，按照病人的脑部磁共振检查分为未合并缺血性脑白质疏松症组(无LA组) 94例和合并缺血性脑白质疏松症组(LA组) 108例。合并缺血性脑白质疏松组按照Fazekas的标准进一步分为轻度LA组61例、中重度LA组47例。多因素logistic回归分析比较血压资料及危险因素与各组缺血性LA的关系。结果：无LA组与轻度LA组、中重度LA组的年龄、肾功能不全史、饮酒史、白天收缩压变异系数差异均有统计学意义(P < 0.017)。轻度LA组与中重度LA组的年龄、饮酒史差异有统计学意义(P < 0.017)。年龄、肾功能不全史、饮酒史、白天收缩压变异系数与LA的疾病程度呈正相关(P < 0.05)，且均是轻度LA、中重度LA的独立危险因素(P < 0.05)。结论：缺血性LA的发生及严重程度与年龄、肾功能不全、饮酒、白天收缩压变异性关系密切。高血压病的治疗应在控制平均血压的同时，通过预防及控制肾功能不全、酒精依赖、血压变异性等综合干预，预防缺血性LA的发生及发展。

Abstract: Objective: To explore the relationship between blood pressure variability, risk factors and ischemic leukoaraiosis (LA) in patients with primary hypertension. Methods: A total of 202 patients with primary hypertension were divided into non-LA group (n = 94) and LA group (n = 108) according to brain magnetic resonance examination. Patients in LA group were further divided into mild LA group (n = 61), moderate-severe LA group (n = 47) according to the Fazekas classification. The rela-tionship between blood pressure, risk factors and ischemic leukoaraiosis was analyzed by poly-tomous logistic regression analysis. Results: There were significant differences in age, history of re-nal insufficiency, history of alcohol consumption, and coefficient of variation of daytime systolic blood pressure between the non-LA group and the mild LA group and moderate-severe LA group (P < 0.017). There were significant differences in age and drinking history between mild LA group and moderate-severe LA group (P < 0.017). Age, history of renal insufficiency, history of alcohol con-sumption and coefficient of variation of daytime systolic blood pressure were positively correlated with the degree of LA (P < 0.05), and were independent risk factors for mild and moderate-severe LA (P < 0.05). Conclusion: The incidence and severity of ischemic LA were closely related to age, re-nal insufficiency, alcohol consumption and the coefficient of variation in daytime blood pressure. The treatment of hypertension should not only control the mean blood pressure, but also prevent and control renal insufficiency, alcohol dependence, blood pressure variability and other compre-hensive interventions to prevent the occurrence and development of ischemic LA.