体位性低血压与脑小血管病综合评分的相关性研究

doi:10.3969/j.issn.1006-7795.2024.03.020

摘要/Abstract

摘要： 目的探究脑小血管病(cerebral small vessel disease, CSVD)患者体位性低血压(orthostatic hypotension, OH)的有无及其类型与CSVD综合评分之间的关系。方法连续入组2021年3月至2023年9月期间的CSVD住院患者460例，根据有无OH及不同OH亚型将所有受试者分为无OH组、早期OH (early OH, EOH) 组及延迟/持续OH (delayed/prolonged OH, DPOH)组。采用0~4分的五分制评分方法评估CSVD综合评分。分别分析不同OH分组与腔隙、脑白质高信号(white matter hyperintensities, WMH)评分、脑微出血 (cerebral microbleeds, CMBs)、基底节区血管周围间隙 (basal ganglia-perivascular spaces, BG-PVS)及CSVD综合评分的相关性。结果入组患者中EOH和DPOH的发生率分别为10.00%和17.17%。各组间存在腔隙的比例、BG-PVS等级及CSVD综合评分的分布差异有统计学意义 (P<0.01)，校正年龄、性别、高血压及卧位舒张压后，DPOH是腔隙 (OR=2.421, 95%CI: 1.372~4.271, P=0.002)、严重BG-PVS (OR=1.714, 95%CI: 1.074~2.740, P=0.024)及更高CSVD综合评分 (OR=1.791, 95%CI: 1.140~2.818, P=0.012)的独立危险因素。结论在CSVD患者中，DPOH较EOH更多见，且是CSVD综合评分增加的独立危险因素。

关键词: 体位性低血压, 脑小血管病综合评分, 腔隙, 基底节区血管周围间隙

Abstract: Objective To investigate the relationship between the presence and type of orthostatic hypotension (OH) and total cerebral small vessel disease (CSVD) score. Methods Consecutive 460 patients were recruited in this study from March, 2021 to September, 2023 and divided into No OH group, Early OH (EOH) group and delayed/prolonged OH (DPOH) group according to the presence and type of OH. A total CSVD score was evaluated using a 5-point scoring method (range 0－4). The correlation was analyzed between different OH groups and lacunes, white matter hyperintensities (WMH) scores, cerebral microbleeds (CMBs), basal ganglia-perivascular spaces (BG-PVS) as well as total CSVD score. Results The prevalence of EOH and DPOH was 10.00% and 17.17%, respectively, in these patients. There are significant differences in the proportion of lacunes and the distribution of degree of BG-PVS as well as total CSVD score among different OH groups (P<0.01). After adjusting for age, gender, hypertension and supine diastolic blood pressure, DPOH was an independent risk factor for lacunes (OR=2.421, 95% CI: 1.372－4.271, P=0.002), severe BG-PVS (OR=1.714, 95% CI:1.074－2.740, P=0.024), and higher total CSVD score (OR=1.791, 95% CI: 1.140－2.818, P=0.012).Conclusion Among CSVD patients, DPOH is more common than EOH and is an independent risk factor for higher total CSVD score.

Key words: orthostatic hypotension (OH), summary cerebral small vessel disease (CSVD) score, lacunes, basal ganglia-perivascular spaces (BG-PVS)

中图分类号:

R743

李悦, 李曼, 左龙, 杨磊, 秦伟, 胡文立. 体位性低血压与脑小血管病综合评分的相关性研究[J]. 首都医科大学学报, 2024, 45(3): 508-514.

Li Yue, Li Man, Zuo Long, Yang Lei, Qin Wei, Hu Wenli. Relationship between orthostatic hypotension and summary cerebral small vessel disease score[J]. Journal of Capital Medical University, 2024, 45(3): 508-514.

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