缺血性脑白质病变患者动态血压的Logistic回归分析
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摘 要 目的:探讨缺血性脑白质病变与动态血压之间的相关性。方法:将100例老年缺血性脑白质病变患者按照Fazekas评分标准,分为WML无-轻度组和WML中-重度组,并行动态血压监测,对患者的有关参数与缺血性脑白质病变的关系进行单因素和多因素分析。结果:单因素分析发现,与WML无-轻度组相比,WML中-重度组年龄较大,高血压患病率高,24小时、白天、夜间平均收缩压及动脉压较高,血压控制较差(P
doi:10.3969/j.issn.1007-614x.2010.17.174
AbstractObjective:To investigate the relationship between 24h Ambulatory blood pressure variables and the severity of White matter ischemic lesions.Methods:A total of 100 patients who underwent 24h ABP monitoring and brain magnetic resonance imaging were recruited.We divided Subjects into absentmild WML group and moderatesevere WML group according to the severity of WML in brain MRI using The Fazekas Scale.The relationship between related index and the severity of WML weretestedwith Univariate logistic regression analysisand Multivariate logistic regression analysis.Results:Univariate logistic regression analysis revealed that,compared with the absentmild WML group,subjects of moderate-severe WML group were significantly older and showed more often a history of hypertension,higher 24hour,day and night average systolic and mean arterial blood pressure levels,poor blood pressure control.However,24hour、day,night diastolic blood pressure,the percentage of night systolic blood pressure decline and night mean arterial blood pressure decline were no significant different between the two groups.Logistic regression analysis showed that age and 24hour average systolic blood pressure were independent risk factors which promoted the occurrence and progression of WML.Conclusion:We should control blood pressure to reach the standard,and prevent the occurrence and progressiona of WML.
Key words white matter ischemic lesions;Ambulatory blood pressure
缺血性脑白质病变(WML)是常见的白质脑病类型之一,该病变可增加中风、认知障碍、痴呆和死亡的危险。高血压是脑白质病变的一个主要危险因素[1],24小时动态血压与靶器官损害的关系比门诊血压更加密切。本研究就缺血性脑白质病变和24小时动态血压的关系进行了分析,现报告如下。
资料与方法
2008年12月～2009年9月收治100例患者,分为两组。WML无-轻度组69例,男52例,女17例,年龄58～89岁,平均7652±071岁;WML中-重度组31例,男23例,女8例,年龄63～94岁,平均80±125岁。排除恶性肿瘤脑转移、多发性硬化、大面积脑出血、脑梗死及其他原因所致的脑白质病变。
方法:①一般检查:对入选患者均行详细的病史询问和体格检查,入院次日清晨抽血检查空腹血糖、血脂和血尿酸,并行头颅MRI检查和无创性24小时动态血压监测。②24小时动态血压监测:入院后在未改变降压药物之前行动态血压监测,设定白天(6am～10pm)每30分钟测血压1次,夜间(10pm～6am)每60分钟测血压1次,连续监测24小时,并记录动态血压各参数。包括24小时平均收缩压(24hSBP)、平均舒张压(24hDBP)、平均动脉压(24hMBP);白昼平均收缩压(dSBP)、平均舒张压(dDBP)、平均动脉压(dMBP);夜间平均收缩压(nSBP)、平均舒张压(nDBP)、平均动脉压(nMBP)。夜间收缩压下降百分率:SBP%=(dSBP-nSBP)/dSBP×100%;夜间动脉压下降百分率:MBP%=(dMBP-nMBP)/dMBP×l00%。24hSBP≥130mmHg和24hDBP≥80mmHg为血压控制差;24小时均值
评分标准:Fazekas量表(0～6分)分别对脑室旁和深部脑白质病变进行评分,两者分数相加为总分。脑室旁评分:0分为无病变;1分为帽状或铅笔样薄层病变;2分为病变呈光滑的晕圈;3分为不规则的脑室旁高信号。深部白质:0分为无病变;1分为点状病变;2分为病变开始融合;3分为病变大面积融合。依照此量表对WML进行评分,将患者分为WML无-轻度组(0～3分)和WML中-重度组(4～6分)。
统计学方法:应用SPSS130统计软件,正态分布计量资料用独立样本t检验,非正态分布计量资料用秩和检验,计数资料采用X2检验,计量资料采用均数X±S表示。多因素分析采用BinaryLogistic回归分析。
结 果
WML单因素分析:与WML无-轻度组相比,WML中-重组的年龄较大,高血压患病率高,24小时、白天、夜间平均收缩压及平均动脉压较高,血压控制情况较差(P
WML患者动态血压Logistic回归分析:将单因素分析筛选出来的因素为自变量进行回归分析。在回归模型中,24小时平均收缩压、年龄为WML独立的危险因素。见表2。
讨 论
缺血性脑白质常见于>65岁人群,可引起轻度认知功能障碍或完全皮质下痴呆,并被认为是患者临床预后不良的标志[2]。资料表明,年龄和高血压是缺血