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学科主题: 神经病学
题名:
长期血压变异性及其与脑微出血的相关性
其他题名: Effects of long-term blood pressure variability on cerebral microbleeds
作者: 刘文宏1; 刘冉1; 孙葳1; 彭清1; 张微微1; 徐恩1; 程焱1; 丁美萍1; 李焰生1; 姚晨1; 黄一宁1
关键词: 血压 ; 脑出血 ; 脑梗死 ; Blood pressure ; Cerebral hemorrhage ; Brain infarction
刊名: 中华神经科杂志
发表日期: 2012
DOI: 10.3760/cma.j.issn.1006-7876.2012.04.011
卷: 45, 期:4, 页:259-263
收录类别: 中国科技核心期刊 ; CSCD
文章类型: Journal Article
摘要: 目的 探讨长期血压变异性的客观存在及其与脑梗死患者脑微出血病变的相关性.方法 多中心连续入组1~6个月的脑梗死患者,随访12~18个月,记录每次随诊血压.采用随诊间血压的最大值(Max)、标准差(SD)、变异系数(CV)评估随诊间血压变异性.计算变异性指标与平均血压的Pearson相关系数,相关者转化为独立于均数的变异性指标,即独立于均数的SD(SDIM).通过计算各血压指标的组内相关系数(ICC)检验组内一致性.入组时和结束随访2周内分别进行MRI 检查.采用MARS评分法评估脑微出血病变.统计学分析血压变异性与脑微出血病变的相关性.结果 720例脑梗死患者,年龄(60.0±10.0)岁,女性225例(31 3%).随访1年结束时,595例(82.6%)随诊14次以上血压,计算第1个7次和第2个7次血压测量值的平均值及其变异性指标的ICC,检验组内一致性,收缩压ICC在0.46 ~0.72,舒张压ICC在0.42~0.69,P值均小于0.01.单因素分析,不论深部、幕下、脑叶区域,微出血组的收缩压和舒张压的均值及变异性指标均高于无微出血组.多因素分析显示深部微出血病变与收缩压Max、SD、CV、SDIM( OR =1.036,95% CI 1.021~1.052,P=0.000; OR=1.060,95%CI 1.001~1.122,P=0.046; OR=1.084,95%CI 1.000~1.175,P=0.049;OR=1.065,95%CI 1.002~1.132,P=0.044)和舒张压SD、CV(OR=1.111,95%CI1.000~1.233,P=0.049;OR=1.091,95% CI.001~1.190,P=0.047)独立相关.幕下微出血与收缩压Max( OR=1.049,95% CI 1.029~1.068,P=0.000)和舒张压SD、CV( OR=1.236,95%CI 1.107~1.379,P=0.000;OR=1.188,95% CI 1.087~1.298,P=0 000)独立相关.脑叶微出血与血压变异性无明显相关.结论 脑梗死患者长期随诊间血压变异性客观存在.血压变异性是不依赖于平均血压的深部及幕下微出血病变的独立危险因素.血压变异性与脑叶微出血无明显相关.不同部位微出血病变与血压关系不同提示可能存在不同的发病机制. Objective To assess the reproducibility of long-term blood pressure variability in ischemic stroke and the association between the variability and cerebral microbleeds.Methods Patients with ischemic stroke at the previous 1-6 months were consecutively recruited and followed up 12-18 months.Blood pressure measurements were taken at every interview.Blood pressure variability indicated visit-to visit variability and was quantified by calculating the maximum ( Max),standard deviation (SD) and coefficient of variation (CV).For these variability might positively correlated with mean of blood pressure,the additional variability measure,SD independent of mean (SDIM),was also calculated.To determine the reproducibility of mean and variability measurements,the intraclass correlation (ICC) was also calculated.MRI was performed at baseline and the end of the study.Cerebral microbleeds were rated using Microbleed Anatomical Rating Scale (MARS).Multiple Logistic regression was used to assess the association between the visit-to-visit blood pressure variability and cerebral microbleeds.Results A total of 720 patients were recruited,of whom 595 (82.6%) subjects were present for 14 blood pressure readings during follow-up.The visit-to-visit blood variability measurements were moderately reproducible according to the ICC:0.46-0.72 for systolic blood pressure (SBP) and 0.42-0.69 for diastolic blood pressure ( DBP),respectively,P <0.01 for all measures.Patients with cerebral microbleeds were more likely to have higher mean blood pressure and variability for both SBP and DBP regardless the distribution of cerebral microbleeds.Being SBP Max,SBP SD,SBP CV,SBP SDIM(OR=1.036,95% CI l.021-1.052,P=0.000; OR=1.060,95%CI 1.001-1.122,P =0.046; OR =1.084,95% CI 1.000-1.175,P =0.049; OR =1.065,95% CI 1.002-1.132,P =0.044) and DBP SD,DBP CV ( OR =1.111,95% CI 1.000-1.233,P =0.049;OR =1.091,95% CI 1.001-1.190,P =0.047) were the independently risk factors of cercbral microbleeds at deep region; SBP Max( OR =1.049,95% CI 1.029-1.068,P =0.000) and DBP SD、DBP CV(OR =1.236,95% CI 1.107-1.379,P=0.000;OR =1.188,95% CI 1.087-1.298,P=0.000)independently associated with cerebral microbleeds at infratentorial location.There was no significant relation between the long-term variability of blood pressure and cerebral microbleeds at lobar region. Conclusions This study indicates that long-term blood pressure variability is substantial and independently associated with cerebral microbleeds in deep or infratentorial but not with that in lobar region.The different relations between the variability and cerebral microbleeds might indicate the heterogenic mechanisms of cerebral microbleeds.
语种: 中文
原文出处: 查看原文
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内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/41126
Appears in Collections:北京大学第一临床医学院_神经内科_期刊论文

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作者单位: 1.100034,北京大学第一医院神经内科
2.北京军区总医院神经科
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4.天津医科大学总医院神经科
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6.上海交通大学医学院附属仁济医院神经科
7.100034,北京大学第一医院
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