高血压病程与脑血流动力学参数及脑白质疏松关系

目的了解高血压病程与脑血流动力学及脑白质疏松（LA）的关系。方法将73例高血压病人，按高血压病程分为4组，A组高血压病程〈5年，B组5～10年，C组11～20年，D组〉20年。所有病人行经颅多普勒超声及颅脑MRI检查，记录大脑中动脉（McA）平均血流速度（Vm）、收缩期峰值血流速度（Vs）、舒张末血流速度（vd）、搏动指数（PI）及LA严重程度，以74例健康体检者作为对照组。结果与对照组比较，B组、C组Vm、Vs显著增快，D组Vd显著减慢，PI显著增大，差异均有显著性（F=7．8～31．9，P＜0．05）。B组、C组、D组LA严重程度较对照组显著增加（Z=-4．74，P＜20．01）。高血压病人年龄、病程、PI、Vd与LA存在明显相关性（r=-O．294～0．706，P＜0．05）。控制年龄、病程、Vd后，McA—PI与LA仍相关（r=O．307，P＜O．05）。结论高血压病人脑血流速度增快，随着高血压病程的增长，脑血流速度有逐渐减慢的趋势。MCA—PI能够预测高血压病人LA病变的严重程度。

RELATIONSHIP BETWEEN COURSE OF HYPERTENSION,CEREBRAL HEMODYNAMICS AND LEUKOARAIOSIS

Objective To understand the relationship between the course of hypertension, cerebral hemodynamics and leukoaraiosis. Methods A total of 73 hypertensive patients were divided into four groups as A, B, C and D according to the course of the disease. Group A, less than five years; group B, 5-10 years; group C, 11-20 years; group D, more than 20 years. All the patients received transcranial Doppler （TCD） and magnetic resonance imaging （MRI） to record the mean velocity （Vm）, systolic velocity （Vs）, diastolic velocity （Vd） and pulsatility index （PI） of middle cerebral artery （MCA） and the severity of leuko araiosis. Seventy-four healthy individuals served as controls. Results Compared with the control subjects, the Vm and Vs in groups B and C were significantly faster, the Vd in group D slower and PI increased, the differences were significant （F= 7.8-31.9, P〈0.05）. The severity of LA in patients in groups B, C and D was higher than the controls （Z=-4.74, P〈0.01）. In the patients, the age, course of the disease, PI, and Vd were obviously correlated wit LA （r= -0.294-0.706,P〈0.05）. MCA-PI was still related significantly to LA score after controlling age, the duration of hypertension and Vd （r=O.307,P〈O.05）. Conclusion The speed of cerebral blood flow in hypertensive patients increases, but, the speed tends to step down along with the increase of the course of the disease. MCA-PI can be used to predict the severity of Lk in patients with hypertension.