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目的探讨动态血压与缺血性脑白质病变(WML)的相关性。方法以2013年1-10月期间在杭州市第一人民医院神经内科住院的106例缺血性脑白质病变患者为研究对象,根据头颅MRI结果,分为无-轻度组(轻度组)和中-重度组(重度组)。监测患者的血压水平,记录动态血压各参数。结果 (1)重度组高血压发生率、低密度脂蛋白胆固醇(LDL-C)、年龄明显高于轻度组,差异有统计学意义(P<0.005);(2)收缩压、最高及最低收缩压、24 h平均舒张压、白天平均舒张压、24 h最高舒张压、白昼及夜间平均动脉压、血压负荷值在两组间差异有统计学意义(P<0.05);(3)Logistic回归分析显示,LDL-C、夜间平均动脉压、24 h最高舒张压、夜晚收缩压标准差是WML的独立危险因素。结论血压水平、血压变异性及血压昼夜节律是WML的重要影响因素,其中夜晚收缩压标准差增高是WML的独立危险因素。
Objective To investigate the relationship between ambulatory blood pressure and ischemic leukodystrophy (WML). Methods One hundred and sixty patients with ischemic leukodystrophy hospitalized in Department of Neurology, First People ’s Hospital of Hangzhou from January to October 2013 were enrolled in this study. According to the results of cranial MRI, the patients were divided into two groups: non - mild group (mild group) And moderate-severe group (severe group). Monitor the patient’s blood pressure levels and record the parameters of ambulatory blood pressure. Results (1) The incidence of hypertension, LDL-C and age in severe group were significantly higher than those in mild group (P <0.005). (2) The systolic blood pressure was the highest and the lowest Systolic blood pressure, mean diastolic blood pressure at 24 hours, mean diastolic blood pressure at daytime, maximum diastolic blood pressure at 24 hours, mean arterial pressure at daytime and nighttime, and blood pressure load were significantly different between the two groups (P <0.05). (3) Logistic regression Analysis showed that LDL-C, nocturnal mean arterial pressure, maximum diastolic blood pressure at 24 h, and standard deviation of night systolic blood pressure were independent risk factors for WML. Conclusion The levels of blood pressure, variability of blood pressure and circadian rhythm of blood pressure are important factors in WML, and the increase of standard deviation of night systolic blood pressure is an independent risk factor of WML.