臂间血压差异与脑小血管病的相关性研究

发布时间：2018-07-10 04:33

本文选题：臂间血压差异 + 脑白质高信号　；参考：《南昌大学》2017年硕士论文

【摘要】：目的:近年来,随着对臂间血压差异(inter-arm blood pressure difference,IAD)研究的深入,其与血管疾病的相关性被越来越多的学者提出并接受。通过医学病理基础及多项临床研究验证,显著的臂间血压差异具有提示外周血管疾病、心血管疾病、脑卒中等疾病的意义,并且还有预测心脑血管疾病发病、预后和死亡的价值。脑白质高信号(white matter hyperintensities,WMH)是脑小血管病(cerebral small vessel disease,CSVD)多种影像学表现中最为重要的一种,可作为判定CSVD存在及严重程度的指标。现在的研究也愈发倾向脑大、小血管疾病在病理发生发展上具有连续性。本临床试验旨在通过测量IAD的大小及评估WMH的程度,探究IAD是否与CSVD的发生相关,可否作为判断CSVD存在及严重程度的方便易得的临床指标。方法:回顾性分析南昌大学第二附属医院神经内科2016年8~12月收治的住院病人,排除感染性、中毒性、外伤性等脑病患者后,共318例。对纳入病人双臂同时同步测量血压2次,计算平均值得出IAD。收集纳入病人基本信息与相关病史:年龄、性别、高血压和糖尿病史、吸烟饮酒史;记录纳入病人检验血脂情况:胆固醇、甘油三酯、低密度脂蛋白以及同型半胱氨酸。通过颅脑磁共振评估病人的WMH情况(0-3分)。按照WMH得分将纳入病人分为4组,对各组以上收集及测量的信息进行比较分析,找出组间有差异的因素并进行相关性分析。再将患有WMH病人分入组1,与无WMH病人组0进行差异比较。结果:318例入选病人,男性162例(50.94%),女性156例(49.06%),年龄15~92岁,平均年龄(67.36±12.29)岁。WMH得0分者87例(27.36%);1分者155例(48.74%);2分者59例(18.55%);3分者17例(5.35%)。4组平均年龄分别为:(58.83±12.42)岁,(68.96±10.13)岁,(73.54±11.19)岁,(75.00±9.89)岁,4组间比较差异有统计学意义(P0.05)。WMH与年龄相关分析:r值0.462,P值0.000,即两者存在正相关性。4组平均臂间收缩压差异(systolic pressure IAD,s IAD)分别为:(3.66±2.36)mmHg,(4.48±3.60)mmHg,(4.58±3.66)mmHg,(8.59±4.41)mmHg,四组间比较差异有统计学意义(P0.05)。4组间平均臂间舒张压差异(diastolic pressure IAD,dIAD)分别为:(4.06±3.66)mm Hg,(4.06±3.42)mm Hg,(5.01±4.03)mm Hg,(6.88±3.52)mmHg,四组间比较差异有统计学意义(P0.05)。WMH与sIAD相关性检验:r值0.164,P值0.003,即存在一定相关性。WMH与d IAD相关性检验:r值0.150,P值0.007,即存在一定相关性。患有WMH的组1病人与无WMH组0病人对比分析:两组间s IAD比较P值0.009(P0.05),差异有统计学意义;两组间dIAD比较P值0.325(P(29)0.05),差异无统计学意义。结论:1、臂间血压差与脑小血管病之间可能存在相关性,在一定程度上可能作为判断脑小血管病存在及严重程度的预测因子,需要更大量样本实验验证。2、收缩压臂间血压差较舒张压臂间血压差可能在判断脑小血管病上更具有监测价值。
[Abstract]:Objective: in recent years, with the in-depth study of inter-arm blood pressure difference (IAD), the correlation with vascular diseases has been put forward and accepted by more and more scholars. The significant difference in the inter arm blood pressure indicates peripheral vascular disease and cardiovascular disease through the medical pathology basis and many clinical studies. White matter hyperintensities (WMH) is the most important one of various imaging manifestations of cerebral small vascular disease (cerebral small vessel disease, CSVD), which can be used as an indicator to determine the existence and severity of CSVD, and to predict the significance of cerebral stroke disease and the prognostic and death value of cerebrovascular disease. The present study is increasingly prone to large brain and small vascular diseases in the progression of pathophysiological development. This clinical trial aims to explore whether IAD is associated with the occurrence of CSVD by measuring the size of IAD and assessing the degree of WMH, and can be used as a convenient and convenient clinical indicator to judge the existence and severity of CSVD. A total of 318 hospitalized patients admitted to the Department of Neurology of the Second Affiliated Hospital of the Second Affiliated Hospital of the Second Affiliated Hospital of the University in 2016 8~12 were excluded from infectious, toxic, traumatic and other encephalopathy. A total of 2 times of blood pressure were measured simultaneously by the simultaneous measurement of the two arms of the patients. The average value of IAD. collection was included in the patient's basic information and related history: age, sex, hypertension and diabetes history. The history of smoking and drinking was recorded in the patients: cholesterol, triglycerides, low density lipoprotein and homocysteine. The patients' WMH status was assessed by craniocerebral MRI (0-3 points). The patients were divided into 4 groups according to the WMH score, and the information of the collection and measurement of each group was compared and analyzed to find the difference between the groups. The WMH patients were divided into group 1 and compared with group 0 without WMH. Results: 318 patients were enrolled, 162 men (50.94%), 156 women (49.06%), age of 15~92, 87 (27.36%) of average age (67.36 + 12.29) years, 0, 1,.4, and.4 The average age of the group was (58.83 + 12.42) years, (68.96 + 10.13) years, (73.54 + 11.19) years and (75 + 9.89) years old. There was a statistically significant difference between the 4 groups (P0.05).WMH and age correlation analysis: the R value 0.462, the P value 0, that is, the difference of the mean inter arm systolic pressure (systolic pressure IAD, s IAD) in the.4 group (3.66 + 2.36) mmH (3.66 + 2.36) mmH G (4.48 + 3.60) mmHg, (4.58 + 3.66) mmHg and (8.59 + 4.41) mmHg, the difference between the four groups was statistically significant (diastolic pressure IAD, dIAD), respectively (4.06 + 3.66) mm Hg, (4.06 + 3.42) AD correlation test: R value 0.164, P value 0.003, that is, the correlation test of correlation.WMH and D IAD: R value 0.150, P value 0.007, that is, there is a certain correlation. The group 1 patients with WMH are compared with the 0 patients without WMH group: two groups of s IAD compared with 0.009, the difference is statistically significant; the difference between two groups is 0.325 (29) 0.05), differences No statistical significance. Conclusion: 1, the correlation between the inter arm blood pressure difference and cerebral small vascular disease may be a predictor of the presence and severity of cerebral small vascular disease to a certain extent. A large number of samples are needed to verify the.2. The difference in systolic pressure between the arm and the systolic pressure between the arms may be used to judge the cerebral small blood vessel disease. It is more valuable in monitoring.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743

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