摘要：
Objective To investigate the correlation between 24 h ambulatory blood pressure monitoring (ABPM) parameters and white matter hyperintensities (WMHs).Methods A cross-sectional analysis was performed in patients who visited the Department of Neurology,Liaoning People's Hospital,and showed WMHs on the head MRI and completed 24 h ABPM in the same period of hospitalization from September 2016 to October 2018.Periventricular white matter hyperintensities (PVWMHs) and deep white matter hyperintensities (DWMHs) were evaluated using the modified Scheltens scale respectively,and the sum of the two was used as the overall severity score of WMHs.The enrolled patients were grouped according to the tertiles of the overall WMH score.Multivariate ordinal logistic regression analysis was used to investigate independent risk factors affecting overall WMH scores.Multivariate linear regression analysis was used to investigate the influencing factors of PVWMH and DWMH scores.Results A total of 201 patients were enrolled,aged (62.7 ± 10.3) years (range 45-88 years),82 males (40.8％),and 123 patients (61.2％) with hypertension.The total WMH scores were 1-27.According to the tertiles,64 patients (31.8％) were divided into lower tertile group (1-3),65 (32.3％) in the middle tertile group (4-8),and 72 (35.8％) in the higher tertile group (9-27).There was significant difference in age between any two WMH score groups,namely,the high tertile group ＞ middle tertile group ＞ low tertile group (69.5 ± 8.5 years vs.63.1 ±9.2 years vs.54.5 ±6.9 years;all P＜0.001).The proportion of hypertension in the middle tertile group (66.2％) and the higher tertile group (69.4％) were significantly higher than those in the lower tertile group (46.9％;all P＜0.05).The homocysteine in the higher tertile group was significantly higher than that in the lower tertile group (15.6 [12.7-19.7]μmol/Lvs.14.1[12.5-15.9]μmol/L;P ＜0.05).In terms of 24 h ABPM parameters,the 24 h mean systolic blood pressure (24 h SBP) in the higher tertile group was higher than that in the lower tertile group,and the nighttime mean systolic blood pressure (nSBP) level in the higher tertile group was higher than that in the lower and middle tertile groups,the SD of daytime systolic blood pressure (dSBPSD) and the SD of the nighttime systolic blood pressure (nSBPSD) in the higher tertile group were higher than those in the lower tertile group,and dSBPSD of the middle tertile group was higher than of the lower tertile group.The above differences were statistically significant (all P ＜0.05).Multivariate ordinal logistic regression analysis showed that the increased age (odds ratio[OR] 1.143,95％ confidence interval[CI] 1.104-1.185;P＜0.001),24 h SBP (OR 1.026,95％ CI 1.005-1.048;P =0.015),dSBP (OR 1.022,95％ CI 1.001-1.043;P =0.036),nSBP (OR 1.026,95％ CI 1.006-1.046;P=0.011),dSBPSD (OR 1.119,95％ CI 1.023-1.221;P=0.013),and nSBPSD (OR 1.107,95％ CI 1.022-1.200;P=0.013) were independently positively correlated with the overall WMH score.Multivariate linear regression showed that age (β=0.607,95％ CI 0.500-0.714;P＜0.001),24 h SBP (β=0.182,95％ CI 0.075-0.289;P=0.001),dSBP (β=0.156,95％ CI 0.049-0.264;P=0.004),and nSBP (β =0.200,95％ CI 0.092-0.307;P ＜0.001) were independently positively correlated with the PVWMH score;age (β =0.505,95％ CI 0.387-0.622;P ＜0.001),24 h SBP (β =0.132,95％ CI 0.015-0.248;P =0.027),dSBP (β =0.127,95％ CI0.011-0.243;P =0.032),nSBP (β =0.148,95％ CI 0.031-0.265;P =0.013),and nSBPSD (β =0.133,95％ CI 0.016-0.250;P=0.027) were independently positively correhted with the DWMH score.Conclusion The increased age,ambulatory systolic blood pressure level (24 h,daytime,nighttime) and systolic blood pressure variability level (dSBPSD and nSBPSD) were independently associated with the severity of WMHs.%目的 探讨24 h动态血压监测(ambulatory blood pressure monitoring,ABPM)参数与脑白质高信号(white matter hyperintensities,WMHs)的相关性.方法 以2016年9月至2018年10月期间就诊于辽宁省人民医院神经内科、头颅MRI提示存在WMHs且住院同期完善24 h ABPM的患者作为研究对象进行横断面分析.使用改良Scheltens量表分别对脑室周围白质高信号(periventricular white matter hyperintensities,PVWMHs)及深部白质高信号(deep white matter hyperintensities,DWMHs)进行评估,两者之和作为总体WMHs严重程度评分.根据入组患者总体WMHs评分的三分位数进行分组.应用有序多分类logistic回归分析探讨影响总体WMHs评分的独立危险因素.应用多元线性回归分析分别探讨PVWMHs和DWMHs评分的独立影响因素.结果 共纳入201例患者,年龄(62.7±10.3)岁(范围45 ～88岁),男性82例(40.8％),伴有高血压123例(61.2％).总WMHs评分为l ～27分,根据三分位数分成低三分位组64例(1～3分,31.8％)、中三分位组65例(4～8分,32.3％)和高三分位组72例(9 ～27分,35.8％).年龄在不同WMHs评分组中两两比较均存在显著差异,即高三分位组＞中三分位组＞低三分位组[(69.5±8.5)岁对(63.1±9.2)岁对(54.5±6.9)岁;P均＜0.001].中三分位组(66.2％)和高三分位组(69.4％)的高血压构成比均显著高于低三分位组(46.9％;P均＜0.05).高三分位组高半胱氨酸显著高于低三分位组[15.6(12.7～19.7)μmol/L对14.1(12.5 ～ 15.9) μmol/L;P＜0.05].在24 h ABPM参数方面,高三分位组24 h平均收缩压(24 h mean systolic blood pressure,24 h SBP)高于低三分位组,高三分位组夜间平均收缩压(nighttime mean systolic blood pressure,nSBP)水平高于低、中三分位组,高三分位组日间收缩压标准差(SDofdaytine systolic blood pressure,dSBPSD)和夜间收缩压标准差(SD of nighttime systolic blood pressure,nSBPSD)高于低三分位组,中三分位组dSBPSD高于低三分位组,上述差异均有统计学意义(P均＜0.05).多变量有序多分类logistic回归分析显示,年龄[优势比(odds ratio,OR)1.143,95％可信区间(confidence interval,CI)1.104～1.185;P＜0.001]、24 h SBP(OR 1.026,95％ CI 1.005～1.048;P =0.015)、dSBP(OR1.022,95％ CI1.001～1.043;P=0.036)、nSBP(OR 1.026,95％ CI1.006～1.046;P=0.011)、dSBPSD(OR1.119,95％ CI 1.023～ 1.221;P=0.013)和nSBPSD(OR1.107,95％ CI1.022～1.200;P=0.013)增高与总体WMHs评分呈独立正相关.多变量线性回归显示,年龄(β=0.607,95％ CI0.500～0.714;P＜0.001)、24 h SBP(β=0.182,95％ CI0.075～0.289;P=0.001)、dSBP(β=0.156,95％ CI0.049 ～0.264;P =0.004)和nSBP(β=0.200,95％ CI0.092 ～0.307;P＜0.001)与PVWMHs评分呈独立正相关;年龄(β=0.505,95％ CI0.387～ 0.622;P＜0.001)、24 h SBP(β=0.132,95％ CI 0.015 ～0.248;P=0.027)、dSBP(β=0.127,95％ CI0.011～0.243;P =0.032)、nSBP(β=0.148,95％ CI0.031～0.265;P=0.013)和nSBPSD(β=0.133,95％ CI0.016 ～0.250;P=0.027)与DWMHs评分呈独立正相关.结论 年龄、动态收缩压水平(24 h、日间、夜间)及收缩压变异性水平(dSBPSD和nSBPSD)增高与WMHs严重程度独立相关.
