缺血性脑血管病患者脑微出血与动态血压的相关性分析

发布时间：2018-06-02 09:16

  本文选题：缺血性脑血管病 + 脑微出血　； 参考：《山东大学》2017年硕士论文

【摘要】：研究背景:随着SWI的广泛应用,临床发现了越来越多的脑微出血(cerebral microbleeds,CMBs)。典型的CMBs是指在SWI上显示的直径在2-5mm,最大不超过10mm的圆形或类圆形低信号病灶,病灶边缘清楚,周围无水肿。目前发现CMBs与脑出血密切相关,可以预测脑卒中的复发,还可引起认知功能障碍、步态障碍、抑郁情绪等中枢神经功能障碍。CMBs的发生与很多因素相关,其中最重要的可逆性危险因素是高血压。血压水平越高,CMBs发生率越高。血压变异性(bloodpressure variability,BPV)是近年来研究较多的血管危险因素,与高血压靶器官损害密切相关。目前BPV与脑卒中研究较多,而与CMBs的相关性研究较少。研究目的:探讨合并CMBs的缺血性脑血管病患者的动态血压特征。研究方法:收集2015年7月至2016年11月至齐鲁医院神经内科的住院的缺血性脑血管患者122人,其中微出血组72例,非微出血组50例。本研究亚组分析中按CMBs部位分为深部、幕下及脑叶三个区域,按照CMBs数量分为无、轻度、中度、重度四组。详细记录患者入院时的年龄、性别、吸烟、饮酒、高血压史、糖尿病史、既往脑血管病史、冠心病病史;入院后24h内测定相关生化指标(总胆固醇、甘油三酯、低密度脂蛋白、载脂蛋白B、同型半胱氨酸、肌酐和尿素氮),完善患者的头颅磁共振成像(MRI)及磁敏感加权成像(SWI)、心电图、超声心动图、颈部血管彩超检查等检查。患者完成24h动态血压监测,包括24h平均收缩压(24hSBP)、24h平均舒张压(24hDBP)、日间平均收缩压(DSBP)、夜间平均收缩压(NSBP)、日间平均舒张压(DDBP)、夜间平均舒张压(NDBP);血压变异性(BPV)包括日间收缩压标准差(DSBP-SD)和日间舒张压标准差(DDBP-SD)、夜间收缩压标准差(NSBP-SD)、夜间舒张压标准差(NDBP-SD)、日间收缩压变异系数(DSBP-CV)、日间舒张压变异系数(DDBP-CV)、夜间收缩压变异系数(NSBP-CV)、夜间舒张压变异系数(NDBP-CV)、夜间收缩压下降率。应用统计分析方法CMBs组患者与无CMBs组患者的相关危险因素分析及动态血压特征。结果:1.一般资料比较CMBs组与无CMBs组进行比较,糖尿病病史、饮酒史、总胆固醇、低密度脂蛋白无显著差异。CMBs组的同型半胱氨酸、高血压病史、吸烟史显著高于无CMBs 组(P0.05)。2.动态血压参数比较CMBs 组 24hSBP、24hDBP、DSBP、DDBP、NSBP、NDBP 高于非 CMBs组,差异有统计学意义(P0.05)。在单因素分析中,24hABPM所得到的短时BPV相关指标中,CMBs组的24hDBP-CV、DDBP-CV 比非 CMBs 组高,ΔSBP、ΔDBP 比非 CMBs 组低,差异有统计学意义。经多因素Logistic回归分析调整,仅有ΔDBP与CMBs相关性有统计学意义(P0.05)。3.不同数量的脑微出血与动态血压的比较根据CMBs的数量分为4组,分别为非CMBs组、轻度CMBs组、中度CMBs组、重度 CMBs 组。结果显示 24hSBP、24hDBP、DSBP、DDBP、NSBP、NDBP随CMBs的增加而增大,差异有统计学意义。中度CMBs组、重度CMBs组的ΔSBP值比非CMBs组低,差异有统计学意义;轻度CMBs组、中度CMBs组、重度CMBs组的ΔDBP比非CMBs组低,差异有统计学意义。4.不同部位的脑微出血与血压变异性的比较按照CMBs在颅内的分布区域不同,将CMBs分为脑叶、深部、幕下、混合四亚组。统计学结果显示24h DBP-CV、DDBP-CV、ΔDBP与脑叶CMBs、深部CMBs、幕下CMBs及混合CMBs均相关,而24h SBP-CV、DSBP-CV、ΔSBP仅和深部CMBs相关,差异有统计学意义。将BPV相关单因素分析有意义的指标与CMBs亚组引入Logistic回归分析模型统计,数据表明DDBP-CV、ΔDBP是深部CMBs的独立危险因素,差异有统计学意义;ΔDBP是幕下及混合CMBs的独立危险因素,差异有统计学意义;脑叶CMBs的发生与24h DBP-CV、DDBP-CV、ΔDBP进行比较,差异无统计学意义。结论:当患者有长期高血压病史并控制不佳、长期吸烟史及高同型半胱氨酸血症时,需高度警惕脑微出血可能,及时行颅脑磁敏感加权序列扫描确诊。血压变异性是CMBs的重要影响因素,其中24hDBP-CV、DDBP-CV、ΔDBP是脑深部CMBs的独立危险因素,DDBP-CV、ΔDBP是幕下CMBs的独立危险因素。对CMBs患者不仅需要关注血压水平,还需行ABPM检查评价血压昼夜波动情况。
[Abstract]:Background: with the extensive use of SWI, more and more cerebral microbleeds (cerebral microbleeds, CMBs) are found. The typical CMBs refers to the circular or circular low signal lesion of 2-5mm, the largest not more than 10mm on SWI, with a clear edge of the lesion and no edema in the circumference. Predicting the recurrence of cerebral apoplexy can also cause cognitive dysfunction, gait disorder, depression and other central nervous dysfunction.CMBs related to many factors. The most important reversible risk factor is hypertension. The higher the level of blood pressure, the higher the incidence of CMBs. Bloodpressure variability (BPV) is the study of recent years. More vascular risk factors are closely related to the damage to target organs of hypertension. At present, there are many studies on BPV and cerebral apoplexy, but there are few studies on the correlation with CMBs. Objective: To investigate the dynamic blood pressure characteristics of patients with ischemic cerebrovascular disease with CMBs. Methods: to collect the hospitalization from July 2015 to November 2016 to the Department of Neurology in Qilu Hospital There were 122 patients with ischemic cerebrovascular disease, including 72 cases of micro bleeding group and 50 cases of non micro bleeding group. In this study, the subgroup analysis was divided into deep, subtentorium and three regions of the brain, divided into no, mild, moderate, and severe four groups according to the number of CMBs, and recorded the age, sex, smoking, drinking, hypertension, and diabetes history of the patients at admission. History of cerebrovascular disease, history of coronary heart disease; Determination of related biochemical indexes in 24h after admission (total cholesterol, triglycerides, low density lipoprotein, apolipoprotein B, homocysteine, creatinine and urea nitrogen), and improving the patient's cranial magnetic resonance imaging (MRI) and magnetic susceptibility weighted imaging (SWI), electrocardiogram, echocardiography, cervical vascular color Doppler examination, etc. Examination. Patients completed 24h ambulatory blood pressure monitoring, including 24h mean systolic pressure (24hSBP), mean 24h diastolic pressure (24hDBP), mean daytime systolic pressure (DSBP), mean night systolic pressure (NSBP), mean daytime diastolic pressure (DDBP), mean night diastolic pressure (NDBP), and blood pressure variability (BPV) including standard difference of daytime systolic pressure (DSBP-SD) and diastolic diastolic pressure (DBP) standard difference (DDBP-SD), night systolic pressure standard deviation (NSBP-SD), nighttime diastolic pressure standard deviation (NDBP-SD), daytime systolic pressure variation coefficient (DSBP-CV), diastolic pressure variation coefficient (DDBP-CV), night systolic pressure variation coefficient (NSBP-CV), night diastolic pressure variation coefficient (NDBP-CV), and night systolic pressure drop rate. Statistical analysis method for CMBs group patients and no CMBs Analysis of related risk factors and dynamic blood pressure characteristics of group patients. Results 1. general data compared with group CMBs and no CMBs group, the history of diabetes, drinking history, total cholesterol, low density lipoprotein had no significant difference in.CMBs group of homocysteine, hypertension history, smoking history was significantly higher than that of non CMBs group (P0.05).2. dynamic blood pressure parameter ratio Compared with group CMBs, 24hSBP, 24hDBP, DSBP, DDBP, NSBP, NDBP were higher than non CMBs groups, and the difference was statistically significant (P0.05). In the single factor analysis, the CMBs group was higher than that of non CMBs group, and the difference was statistically significant. The correlation between only Delta DBP and CMBs was statistically significant (P0.05). The comparison of the number of cerebral microbleeds and dynamic blood pressure in different numbers of.3. was divided into 4 groups according to the number of CMBs, which were non CMBs, mild CMBs, moderate CMBs, and severe CMBs. The results showed 24hSBP, 24hDBP, DSBP, and the difference was statistically significant. The value of delta SBP in the moderate CMBs group and the severe CMBs group was lower than that in the non CMBs group, and the difference was statistically significant. The delta DBP in the mild CMBs group, the moderate CMBs group and the severe CMBs group was lower than the non CMBs group. The difference was statistically significant in the difference between the brain microbleeding and the blood pressure variability in the.4. different parts of the.4., and the CMBs was divided into the lobes, and the CMBs was divided into the lobes, and the depth was divided into the lobes of the brain. The statistical results showed that 24h DBP-CV, DDBP-CV, and delta DBP were related to CMBs, CMBs, CMBs and mixed CMBs in the deep part of the brain, and 24h SBP-CV, DSBP-CV, and delta SBP only correlated with the depth. The data showed that DDBP-CV, Delta DBP was an independent risk factor of deep CMBs, and the difference was statistically significant; Delta DBP was an independent risk factor for the sub episodes and mixed CMBs, and the difference was statistically significant. The difference between CMBs and 24h DBP-CV, DDBP-CV, and delta DBP was not statistically significant. In the history of long-term smoking and hyperhomocysteinemia, it is necessary to be highly alert for the possibility of cerebral microhemorrhage and be diagnosed with brain magnetic sensitivity weighted sequence scan in time. Blood pressure variability is an important factor in CMBs, of which 24hDBP-CV, DDBP-CV, and delta DBP are independent risk factors of CMBs in the deep brain, DDBP-CV, and delta DBP is an independent risk factor for sub episodes CMBs. MBs patients not only need to pay attention to blood pressure level, but also need ABPM examination to evaluate the circadian fluctuation of blood pressure.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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