血压因素在皮质下动脉硬化性脑病中的作用

探讨血压因素在皮质下动脉硬化性脑病白质损害中的作用。患者35例,均有高血压病史。采用动态检测技术观察血压的变化。利用CT机影像密度计法测定大脑白质低密度范围、白质萎缩程度及全脑萎缩程度。对所得血压及CT结果进行单因素相关性分析和逐步回归分析。结果显示,患者脑CT改变与高血压病程、24小时平均收缩压及收缩压波动密切相关,但各项血压指标在不同方程中的贡献率有所不同。大脑白质低密度范围与高血压病程关系最为密切,而脑萎缩程度与血压波动关系最密切。提示长期高血压是造成白质低密度的重要因素,而患者脑实质的丢失主要与血压波动有关。鉴于随测血压未能进入回归方程,所以强调动态监测患者血压。

The role of blood pressure in subcortical arteriosclerotic encephalopathy

To assess the role of some blood pressure factors in the lesions of white matter in subcortical arteriosclerotic encephalopathy. 35 patients, all with history of hypertension, were' investigated. Using dynamic monitoring techniques, blood pressure variables were examined. With densitometric methods, the severity of white matter low attenuation, leuko-atrophy and atrophy of the whole brain were measured. To estimate the relative contributions of blood pressure factors to the severity of white matter lesions and cerebral atrophy, stepwise regression analyses were performed. CT changes were regarded as the dependent variables and blood pressure factors as expanatory variables. The results showed that after controlling for age, the regression models identified hypertension duration, daily mean systolic pressure and systolic pressure fluctuation were associated with white matter low attenuation as well as cerebral atrophy. .Hypertension duration showed strongest prdictive effect to white matter low attenuation. On the contrary, cerebral atrophy correlated with blood pressure fluctuation most significantly. The data suggest that the duration of hypertension history is the most important blood pressure factor to white matter low atenuation, while daily variability of blood pressure i.s the most important factor to cerebral parenchymal lose, stressing the need for dynamic investigation of blood pressure regard of the absence of a predictive effect of casual blood pressure.