24小时动态血压变化与高血压合并脑白质病变的关系

发布时间：2018-03-15 03:22

本文选题：脑白质病变　切入点：高血压　出处：《皖南医学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:脑白质病变(White matter lesions,WML)造成脑部组织损伤的病理过程有很强的异质性,发病的危险因素多种多样,患者表现出来的临床症状和体征也可不尽相同。目前该病的具体发病机制和有关危险因素尚处于研究阶段。本研究主要对与WML部位及程度相关的血管危险因素进行分析的基础上,强调高血压患者血压动态变化的血压变异性(Blood pressure variability,BPV)对WML的影响,对高血压患者脑白质病变部位及严重程度与BPV的相关性进行了详细探讨,对WML可能的病理生理机制进行初步探索。方法:选择2014年09月到2016年10月之间,在芜湖市第二人民医院神经内科、急诊内科住院的病人,进行过脑血管病危险因素筛查且年龄为50岁及其以上的高血压患者作为研究对象。收集所有研究对象的临床病历资料,并对其进行24h动态血压监测(Ambulatory blood pressuremonitoring,ABPM)和脑部磁共振(MRI)检查。其中临床病历资料完整的共178例,以颅脑MRI结果为依据分为两组:一组为脑白质病变组(WML组),共计112例;另一组为无脑白质病变组(无WML组),共计66例。再依据Fazekas评分将WML组患者分为两种类型,即脑室旁白质病变(Periventricular lesions,PVL)和皮质下深部白质病变(Deep white matter lesions DWML),同时还要对每种类型的病变程度进行评估。此外,还应对每位患者的血压变化进行24h动态监测,并对其白天(day)、夜间(night)、昼夜的血压平均值[收缩压(Systolic blood pressure,SBP)、舒张压(Diastolic blood pressure,DBP)]及血压变异系数(Coefficient of variability,CV)进行详细记录,对其24hSBP及24hDBP的峰谷数值进行统计,以此作为动态血压参数。使用单因素和多因素logistic回归分析方法,研究动态血压参数及传统血管危险因素对脑白质病变部位是否有影响;对各部位危险因素及动态血压参数与具体病变程度进行pearson或spearman相关分析,重点观察动态血压参数对脑白质各部位病变程度的影响。结果:1.wml组与无wml组临床病历资料的比较:与无wml组相比,wml组患者平均年龄更大,有更长的高血压病史,同型半胱氨酸(homocysteine,hcy)水平更高(p0.05);两组患者动态血压参数相比较:wml组的24hdbp,24hsbp,dsbp,nsbp,24hsbp-cv,dsbp-cv,24hsbp谷峰值都比无wml组更高(p0.05)。2.pvl危险因素分析:以动态血压参数以及传统血管危险因素(如性别、年龄、高脂血症、高血压病程等)为协变量,pvl为因变量,进行单因素分析可得出:年龄、同型半胱氨酸、高血压病程、nsbp、dsbp、24hsbp、24hsbp-cv、dsbp-cv、24hsbp-谷峰值共9个指标均是pvl的可能影响因素,且具有统计学意义(p0.05);再将这9个指标进行多因素logistic回归分析发现:年龄、高同型半胱氨酸、dsbp-cv、24hsbp-谷峰值这4个指标均是pvl的危险因素,其计算出的or值分别为1.719、1.046、4.093、1.079,其中dsbp-cv是pvl的最重要的危险因素。3.dwml的危险因素:以动态血压参数以及传统血管危险因素(如性别、年龄、饮酒、高脂血症、高血压病程等)为协变量,dwml为因变量,进行单因素分析可得出:年龄、高同型半胱氨酸血症、饮酒、高血压病程、nsbp、dsbp、24hsbp、24hsbp-cv、dsbp-cv,24hsbp-谷峰值共10个指标均是dwml的可能影响因素,且具有统计学意义(p0.05);再将这10个指标进行多因素logistic回归分析可发现:饮酒、dsbp-cv、24hdbp、24hsbp-谷峰值这4个指标均是dwml的危险因素,其计算出的or值分别为3.167、6.571、1.062、1.079,其中dsbp-cv是dwml的最重要的危险因素。4.与pvl程度相关的因素分析:将pvl的危险因素与其病变程度分级进行相关分析可发现:pvl1级病变与24hsbp-谷峰值有相关性;而pvl2级、3级病变与年龄、高同型半胱氨酸血症、dsbp-cv、24hsbp-谷峰值均有相关性。5.与DWML程度相关的多危险因素分析:将DWML的危险因素与其病变程度分级进行相关分析,可发现:DWML1级病变与24hSBP-谷峰值有相关性;而2级病变与dSBP-CV,24hSBP-谷峰值均有相关性;3级病变与24hDBP、dSBP-CV、24hSBP-谷峰值均有相关性。结论:1?不同部位及不同程度的WML,其危险因素并不完全相同;2?与PVL及DWML相关的动态血压参数具有重叠性和差异性;3?高血压的动态血压参数与各级PVL及DWML均存在相关性,动态血压参数的上升,其病变等级逐渐升高。
[Abstract]:Objective: cerebral white matter lesions (White matter, lesions, WML) caused by the pathological process of brain injury is very heterogeneous, the risk factors of various clinical symptoms and signs shown can be not the same. At present the specific mechanisms of the disease and related risk factors is still in the research stage the purpose of this study. Based on the analysis of related WML site and degree of vascular risk factors, blood pressure variability on the dynamic changes of blood pressure in hypertensive patients (Blood pressure, variability, BPV) on the WML, the correlation between cerebral white matter lesions in patients with hypertension location and severity and BPV are discussed in detail, for to explore the pathophysiological mechanism of WML. Methods: in 2014 09 months to October 2016, in the Department of Neurology Wuhu Second People's Hospital, emergency internal medicine hospital patient, too The risk factors for cerebrovascular disease screening and the age of 50 and older hypertension patients as the research object. The clinical data were collected from all participants, and 24h ambulatory blood pressure monitoring on the (Ambulatory blood pressuremonitoring, ABPM) and brain magnetic resonance imaging (MRI) examination. The clinical data of 178 cases with complete. Based on the results of brain MRI were divided into two groups: one group of cerebral white matter lesion group (WML group), a total of 112 cases; another group without cerebral white matter lesion group (WML group), 66 cases in total. According to the Fazekas score of WML group were divided into two types, namely periventricular white (Periventricular lesions, PVL matter lesions) and subcortical white matter lesions (Deep white matter lesions DWML), but also on the severity of each type were evaluated. In addition, the change of blood pressure also respond to each patient's 24h dynamic monitoring, and the daytime (DA Y (night)), the night, day and night average systolic blood pressure [(Systolic blood pressure, SBP), diastolic blood pressure (Diastolic blood, pressure, DBP) and blood pressure variability (Coefficient of, variability, CV) were recorded, the peak and valley of its 24hSBP and 24hDBP numerical statistics, as a dynamic the blood pressure parameters. Using univariate and multivariate logistic regression analysis method to study whether ambulatory blood pressure parameters and traditional vascular risk factors have influence on cerebral white matter lesions; Pearson or Spearman correlation analysis of each part of the risk factors and the parameters of ambulatory blood pressure and specific lesions, observed the influence on ambulatory blood pressure parameters on the degree of brain parts white matter lesions. Results: compared with 1.wml group and non WML group of clinical data: compared with non WML group, the average age of WML group were larger, have a longer history of high blood pressure, homocysteine (Homo Cysteine, Hcy) higher level (P0.05); the two groups were compared: the parameters of ambulatory blood pressure in group WML, 24hdbp, 24hsbp, dsbp, nsbp, 24hsbp-cv, dsbp-cv, 24hsbp and Gu Feng were higher than no WML group (P0.05):.2.pvl analysis of risk factors on ambulatory blood pressure parameters and traditional vascular risk factors (such as gender, age, hyperlipidemia, hypertension etc.) as covariates, PVL as the dependent variable, the single factor analysis: age, homocysteine, duration of hypertension, nsbp, dsbp, 24hsbp, 24hsbp-cv, dsbp-cv, 24hsbp- Valley peak a total of 9 indicators are factors that may affect PVL, and has statistical significance (P0.05); then logistic regression analysis found that the factors of the 9 indexes: age, high homocysteine, dsbp-cv Gu Feng, 24hsbp- value of the 4 indicators are the risk factors of PVL, the calculated or = 1.719,1.046,4.093,1.079, where dsbp-cv is PVL The risk factors of.3.dwml the most important risk factors: the ambulatory blood pressure parameters and traditional vascular risk factors (such as gender, age, alcohol, hyperlipidemia, hypertension etc.) as covariates, DWML as the dependent variable, the single factor analysis: age, hyperhomocysteinemia, drinking, hypertension duration. Nsbp, dsbp, 24hsbp, 24hsbp-cv, dsbp-cv, 24hsbp- and Gu Feng value of a total of 10 indicators are all factors that may affect the DWML, which has statistical significance (P0.05); then logistic regression analysis can be found by multiple factors and the 10 indexes: dsbp-cv, 24hdbp, 24hsbp- alcohol, Gu Feng value of the 4 indicators are dangerous DWML, the calculated or = 3.167,6.571,1.062,1.079, where dsbp-cv is the DWML analysis of the most important risk factors related to.4. and PVL factors: PVL risk classification for hormone and disease severity related analysis Found: Gu Feng disease and 24hsbp- pvl1 value and correlation; grade pvl2, grade 3 lesions with age, hyperhomocysteinemia, dsbp-cv,.5. and DWML correlation analysis showed the degree of multiple risk factors in 24hsbp- Gu Feng: the risk factors of DWML and severity level correlation analysis, it can be found that Gu Feng grade lesions of 24hSBP- and DWML1 value and correlation; 2 lesions were correlated with dSBP-CV, 24hSBP- and Gu Feng; 3 lesions with 24hDBP, dSBP-CV and 24hSBP- were correlated with Gu Feng value. Conclusion: 1? Different parts and different degree of WML, the risk factors are not the same; 2? Ambulatory blood pressure parameters associated with PVL and DWML has overlapping and differences; 3? Hypertension ambulatory blood pressure and the levels of PVL and DWML there was a correlation between increased ambulatory blood pressure parameters, the lesion level gradually increased.

【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R544.1;R742

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