中华神经医学杂志
中華神經醫學雜誌
중화신경의학잡지
CHINESE JOURNAL OF NEUROMEDICINE
2012年
6期
613-618
,共6页
余传庆%张梅%朱蕾%余亮
餘傳慶%張梅%硃蕾%餘亮
여전경%장매%주뢰%여량
缺血性脑血管病%动脉粥样硬化性狭窄%血压变异系数%平均血压标准差%危险因素
缺血性腦血管病%動脈粥樣硬化性狹窄%血壓變異繫數%平均血壓標準差%危險因素
결혈성뇌혈관병%동맥죽양경화성협착%혈압변이계수%평균혈압표준차%위험인소
Ischemic cerebrovascular disease%Cerebral arterial stenosis%Coefficient of blood pressure variability%Average blood pressure standard deviation%Risk factor
目的 探讨缺血性脑血管病患者脑动脉粥样硬化性狭窄与血压变异性的关系. 方法 选择自2006年11月至2010年6月在淮南市第一人民医院神经内科住院的206例缺血性脑血管病患者为研究对象,对患者进行连续主动脉弓+全脑血管造影检查,并作动脉血压监测.根据造影结果分组,并对其临床资料进行回顾性分析. 结果 (1)206例患者中75例颅内外动脉无狭窄,131例存在脑动脉狭窄,其中42例仅有颅外动脉狭窄,38例仅有颅内动脉狭窄,51例颅内外狭窄并存；颅外动脉狭窄的发生率(71.0％,93例)高于颅内动脉(67.9％,89例).(2)与颅内外动脉无狭窄组比较.单纯颅外动脉狭窄组、单纯颅内动脉狭窄组、颅内外动脉狭窄并存组24h平均收缩压、舒张压标准差,白昼平均收缩压、舒张压标准差,夜间平均收缩压、舒张压标准差均明显增大,差异有统计学意义(P＜0.05).(3)收缩压变异系数与脑动脉狭窄患病率成正相关(r=0.918,P=0.002),而舒张压变异系数与脑动脉狭窄发患病率无明显相关性(P＞0.05);24 h平均收缩压与脑动脉狭窄患病率成正相关(r=0.936,P=0.001),而24 h平均舒张压与脑动脉狭窄患病率无明显相关性(P＞0.05).(4)多元回归分析显示:24h平均收缩压、收缩压变异系数与颅内外动脉狭窄患病率呈明显正相关.(5)血脂异常是单纯颅内动脉狭窄的独立危险因素；高龄是单纯颅外动脉狭窄的独立危险因素；吸烟是单纯颅内动脉狭窄及单纯颅外动脉狭窄的独立危险因素；高血压是单纯颅外动脉狭窄及颅内外动脉狭窄并存的独立危险因素. 结论 在缺血性脑血管病患者中,脑动脉狭窄与平均血压标准差、收缩压变异系数独立相关.高血压、高脂血症、冠心病、吸烟、高龄、糖尿病和高同型半胱氨酸血症等危险因素与脑动脉狭窄的分布模式有一定关系.动脉血压变异性是缺血性脑血管病患者颅内外狭窄的独立危险因素,但与狭窄的分布模式无相关性.
目的 探討缺血性腦血管病患者腦動脈粥樣硬化性狹窄與血壓變異性的關繫. 方法 選擇自2006年11月至2010年6月在淮南市第一人民醫院神經內科住院的206例缺血性腦血管病患者為研究對象,對患者進行連續主動脈弓+全腦血管造影檢查,併作動脈血壓鑑測.根據造影結果分組,併對其臨床資料進行迴顧性分析. 結果 (1)206例患者中75例顱內外動脈無狹窄,131例存在腦動脈狹窄,其中42例僅有顱外動脈狹窄,38例僅有顱內動脈狹窄,51例顱內外狹窄併存；顱外動脈狹窄的髮生率(71.0％,93例)高于顱內動脈(67.9％,89例).(2)與顱內外動脈無狹窄組比較.單純顱外動脈狹窄組、單純顱內動脈狹窄組、顱內外動脈狹窄併存組24h平均收縮壓、舒張壓標準差,白晝平均收縮壓、舒張壓標準差,夜間平均收縮壓、舒張壓標準差均明顯增大,差異有統計學意義(P＜0.05).(3)收縮壓變異繫數與腦動脈狹窄患病率成正相關(r=0.918,P=0.002),而舒張壓變異繫數與腦動脈狹窄髮患病率無明顯相關性(P＞0.05);24 h平均收縮壓與腦動脈狹窄患病率成正相關(r=0.936,P=0.001),而24 h平均舒張壓與腦動脈狹窄患病率無明顯相關性(P＞0.05).(4)多元迴歸分析顯示:24h平均收縮壓、收縮壓變異繫數與顱內外動脈狹窄患病率呈明顯正相關.(5)血脂異常是單純顱內動脈狹窄的獨立危險因素；高齡是單純顱外動脈狹窄的獨立危險因素；吸煙是單純顱內動脈狹窄及單純顱外動脈狹窄的獨立危險因素；高血壓是單純顱外動脈狹窄及顱內外動脈狹窄併存的獨立危險因素. 結論 在缺血性腦血管病患者中,腦動脈狹窄與平均血壓標準差、收縮壓變異繫數獨立相關.高血壓、高脂血癥、冠心病、吸煙、高齡、糖尿病和高同型半胱氨痠血癥等危險因素與腦動脈狹窄的分佈模式有一定關繫.動脈血壓變異性是缺血性腦血管病患者顱內外狹窄的獨立危險因素,但與狹窄的分佈模式無相關性.
목적 탐토결혈성뇌혈관병환자뇌동맥죽양경화성협착여혈압변이성적관계. 방법 선택자2006년11월지2010년6월재회남시제일인민의원신경내과주원적206례결혈성뇌혈관병환자위연구대상,대환자진행련속주동맥궁+전뇌혈관조영검사,병작동맥혈압감측.근거조영결과분조,병대기림상자료진행회고성분석. 결과 (1)206례환자중75례로내외동맥무협착,131례존재뇌동맥협착,기중42례부유로외동맥협착,38례부유로내동맥협착,51례로내외협착병존；로외동맥협착적발생솔(71.0％,93례)고우로내동맥(67.9％,89례).(2)여로내외동맥무협착조비교.단순로외동맥협착조、단순로내동맥협착조、로내외동맥협착병존조24h평균수축압、서장압표준차,백주평균수축압、서장압표준차,야간평균수축압、서장압표준차균명현증대,차이유통계학의의(P＜0.05).(3)수축압변이계수여뇌동맥협착환병솔성정상관(r=0.918,P=0.002),이서장압변이계수여뇌동맥협착발환병솔무명현상관성(P＞0.05);24 h평균수축압여뇌동맥협착환병솔성정상관(r=0.936,P=0.001),이24 h평균서장압여뇌동맥협착환병솔무명현상관성(P＞0.05).(4)다원회귀분석현시:24h평균수축압、수축압변이계수여로내외동맥협착환병솔정명현정상관.(5)혈지이상시단순로내동맥협착적독립위험인소；고령시단순로외동맥협착적독립위험인소；흡연시단순로내동맥협착급단순로외동맥협착적독립위험인소；고혈압시단순로외동맥협착급로내외동맥협착병존적독립위험인소. 결론 재결혈성뇌혈관병환자중,뇌동맥협착여평균혈압표준차、수축압변이계수독립상관.고혈압、고지혈증、관심병、흡연、고령、당뇨병화고동형반광안산혈증등위험인소여뇌동맥협착적분포모식유일정관계.동맥혈압변이성시결혈성뇌혈관병환자로내외협착적독립위험인소,단여협착적분포모식무상관성.
Objective To investigate the relationship of blood pressure variability (BPV) with cerebral artery stenosis in patients with ischemic cerebrovascular disease. Methods Two hundred and six consecutive patients with ischemic cerebrovascular disease,admitted to our hospital from November 2006 to June 2010, were chosen in our study; these patients underwent arcus aorta and cerebral angiographies, and were monitored the ambulatory blood pressure. And then, according to the angiographic findings, the risk factors and relevant clinical data of different groups were analyzed.Results (1) Seventy-five of the 206 patients had normal findings in angiography and 131 had occlusive lesions of different degrees,among which 32.1％ (42) had only extracranial artery disease (EAD),29.0％(38) had only intracranial artery disease (IAD),and 38.9％ (51) had both EAD and IAD.In total,the incidence of EAD was 71.0％ (93),which was higher than that of IAD (67.9％,89).(2) As compared with those in the normal group,standard deviation of 24 h systolic blood pressure (24hSBPSD),standard deviation of 24 h diastolic blood pressure (24hDBPSD),day SBPSD (dSBPSD),day DBPSD (dDBPSD),night SBPSD (nSBPSD) and night DBPSD (nDBPSD) were significantly higher in the cerebral artery stenosis group (P＜0.05). (3) The prevalence of cerebral artery steonsis was positively correlated with coefficient of systolic variation (r=0.918, P=0.002); no significant correlation was noted between coefficient of 24 h diastolic variation and the prevalence of cerebral artery stenosis (P＞0.05); coefficient of 24 h mean systolic variation was positively correlated with prevalence of cerebral artery stenosis (r=0.936,P=0.001); and 24 h mean diastolic blood pressure was negatively correlated with prevalence of cerebral artery stenosis (P＞0.05). (4) Multivariate regression analysis indicated that cerebral steno-occlusive lesion was positively associated with 24 h mean systolic blood pressure and coefficient of variation of 24 h blood pressure.(5) Hyperlipidemia was the independent risk factor for EAD; advanced age was the independent risk factor for IAD; and smoke was the independent risk factor for EAD and IAD; coronary artery disease was the independent risk factor for EAD,and EAD combined with IAD.Conclusion Cerebral artery stenosis is independently associated with standard deviation of mean of blood pressure and coefficient of variation systolic blood pressure; the contribution of various risk factors,including hypertension,hyperlipidemia,coronary artery disease,smoking,advanced age,diabetes and hyperho-mocysteinemia, have some correlation with the distribution mode of stenosis; BPV is an independent risk factor for cerebral artery stenosis,but not related to the distribution mode of stenosis.
