目的：探讨老年高血压患者不稳定性颈动脉斑块与腔隙性脑梗死、脑白质病变及认知功能障碍的关系。方法选择2010年10月-2012年12月在我科住院的老年高血压患者64例，根据颈动脉斑块性质将患者分为稳定性斑块组27例和不稳定性斑块组37例；另选同期在我院体检血压正常且无颈动脉粥样硬化的老年人38例为对照组。检测所有受试者血脂、血压，行颈动脉超声检查、颅脑CT检查，采用改良中文版蒙特利尔认知评估量表（ MoCA量表）进行认知功能测定。结果不稳定性斑块组LDL水平高于稳定性斑块组，HDL水平低于稳定性斑块组，收缩压高于对照组（P＜0.05）。3组受试者颈总动脉和颈内动脉内膜中层厚度（IMT）比较，差异均无统计学意义（P ＞0.05）。不稳定性斑块组2型糖尿病、脑白质病变及认知功能障碍发生率高于稳定性斑块组和对照组，腔隙性脑梗死发生率低于稳定性斑块组、高于对照组（ P＜0.05）；稳定性斑块组2型糖尿病、腔隙性脑梗死、脑白质病变及认知功能障碍发生率均高于对照组（ P＜0.05）。不稳定性斑块组MoCA量表分项视空间与执行能力、延迟回忆得分均较稳定性斑块组和对照组降低（P＜0.05）。线性相关分析结果显示，不稳定性斑块检出率与脑白质病变发生率呈正相关（r=0.187，P＜0.05），与HDL水平呈负相关（r=-0.536，P=0.033），与腔隙性脑梗死、认知功能障碍发生率均无直线相关性（P＞0.05）。结论老年高血压伴颈动脉不稳定性斑块形成患者腔隙性脑梗死、脑白质病变及认知功能障碍发生率增高，血脂异常是导致颈动脉粥样硬化的重要因素，在对老年高血压患者进行治疗时，应配合合理的调脂治疗及膳食干预。%Objective To investigate the relationship of carotid atherosclerosis( CA) with lacunar infarction( LI), leukoencephalopathy( LE) and cognition disorders in elderly hypertension patients. Methods A total of 64 elderly hyperten-sion patients hospitalized in this hospital from October 2010 to December 2012 were divided,according to properties of carotid plaque,into groups A(with stable plaque,n=27),B(with unstable plaque,n=37);another 38 healthy elderly subjects without CA were enrolled as control group. Blood fat,blood pressure were detected,carotid ultrasound and brain CT scan car-ried out,cognitive function determined by Montreal Cognitive Assessment scale( MoCA scale). Results LDL level was higher in group B than in group A,HDL lower,SBP higher in group B than in control group(P<0. 05). There was no significant difference in IMT of common carotid artery and internal carotid artery in 3 groups(P>0. 05). The incidences of T2DM,LE and cognitive function were higher in group B than in groups A,control,and LI incidence lower than in group A,but higher than in control group(P<0. 05). The incidences of T2DM,LI,LE,cognition disorders were higher in group A than in group control(P<0. 05). The scores of visuospatial,executive ability,delayed recall in MoCA scale were lower in group B than in groups A,control(P<0. 05). By results of linear correlation analysis,the detection rate of unstable plaque was positively cor-related with incidence of LE(r=0. 187,P<0. 05),negatively with HDL level(r= -0. 536,P=0. 033),not linearly cor-related with incidences of LI and cognition disorders(P>0. 05). Conclusion The incidences of LI,LE,cognition disorders are higher in elderly patients with hypertension combined with unstable carotid plaque,and dyslipidemia is an important factor leading to CA. Lipid-lowering therapy and dietary intervention should be given when treating elderly hypertension patients.
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