原发性高血压病患者血压波动性与颅内外动脉狭窄的关系研究

摘要

目的 探讨原发性高血压病患者血压波动性(BPV)与颅内外动脉狭窄的关系及其对颅内外动脉狭窄发生的预测价值.方法 选取2013年8月-2015年10月在北京大学人民医院住院的原发性高血压病患者共80例.对患者进行24 h动态血压监测(ABPM),以血压读数的标准差(SD)代表BPV值.采用CT血管造影(CTA)和/或磁共振血管造影(MRA)诊断患者颅内外动脉的狭窄程度.采用Spearman相关性分析探讨原发性高血压病患者BPV与颅内外动脉狭窄的关系,采用受试者工作特征(ROC)曲线评价24 h BPV预测颅内外动脉狭窄发生的价值.结果 Spearman相关分析结果显示,24 h、昼间的BPV与颅内外动脉狭窄呈正相关(P<0.05).24 h收缩压SD对颅内外动脉狭窄预测的ROC曲线下面积为0.712〔95％CI(0.595,0.829),P=0.004〕;24 h舒张压SD对颅内外动脉狭窄预测的ROC曲线下面积为0.690〔95％CI(0.568,0.812),P=0.009〕.结论 24 h、昼间的BPV与颅内外动脉狭窄呈正相关,24 h BPV对颅内外动脉狭窄的发生有一定的预测价值.%Objective To explore the relationship between blood pressure variability (BPV)and intracranial/extracranial artery stenosis in primary hypertensive patients,and the value of BPV on predicting intracranial/ extracranial arterial stenosis. Methods The enrolled participants were 80 primary hypertensive patients who received inpatient treatment from Peking University People′s Hospital from August 2013 to October 2015. 24 h ambulatory blood pressure monitoring (ABPM)were performed. BPV was assessed as the within - subject standard deviation of blood pressure readings. CT angiography (CTA)and/ or magnetic resonance angiography (MRA)examinations were performed to diagnose the stenosis of the intracranial/ extracranial artery stenosis. Spearman correlation analysis was conducted to investigate the relationship between BPV and intracranial/extracranial artery stenosis in primary hypertension. ROC curve analysis was carried out to assess the value of 24 h BPV for the prediction of intracranial/ extracranial arterial stenosis. Results The Spearman correlation analysis showed that both 24 h BPV and daytime BPV were positively correlated with the severity of intracranial/ extracranial artery stenosis (P < 0. 05). The area under the ROC curve of 24 h systolic SD for the prediction of intracranial/ extracranial artery stenosis was 0. 712 〔95％ CI (0. 595,0. 829),P = 0. 004〕. The area under the ROC curve of 24 h diastolic SD for the prediction of intracranial/ extracranial artery stenosis was 0. 690 〔95％ CI (0. 568,0. 812 ),P = 0. 009〕. Conclusion 24 h BPV and daytime BPV were significantly related to intraeranial/ extracranial artery stenosis. 24 h BPV could predict the occurrence of intracranial/ extracranial artery stenosis.