目的 探讨动态血压与缺血性脑白质病变(WML)的相关性.方法 以2013年1-10月期间在杭州市第一人民医院神经内科住院的106例缺血性脑白质病变患者为研究对象,根据头颅MRI结果,分为无-轻度组(轻度组)和中-重度组(重度组).监测患者的血压水平,记录动态血压各参数.结果 (1)重度组高血压发生率、低密度脂蛋白胆固醇(LDL-C)、年龄明显高于轻度组,差异有统计学意义(P＜0.005);(2)收缩压、最高及最低收缩压、24 h平均舒张压、白天平均舒张压、24 h最高舒张压、白昼及夜间平均动脉压、血压负荷值在两组间差异有统计学意义(P＜0.05);(3)Logistic回归分析显示,LDL-C、夜间平均动脉压、24 h最高舒张压、夜晚收缩压标准差是WML的独立危险因素.结论 血压水平、血压变异性及血压昼夜节律是WML的重要影响因素,其中夜晚收缩压标准差增高是WML的独立危险因素.%Objective To investigate the correlation between ambulatory blood pressure changes and white matter ischemic lesions (WML).Methods A total of 106 patients were analyzed retrospectively.All patients were divided into absent/mild group and moderate/severe group according to magnetic resonance imaging (MRI).The ambulatory blood pressure monitor was used to measure the blood pressure parameters of the patients.Results Ihe incidence of hypertension,low density lipoprotein,and age levels were significantly higher in the moderate/severe group than that in the absent/mild group (P＜0.05).Multiple blood pressure parameters were significantly different between the two groups including the mean systolic pressure,the highest and lowest systolic blood pressure,24 h mean diastolic blood pressure,daytime diastolic blood pressure,the highest 24-h diastolic blood pressure,mean arterial pressure in daytime and nighttime and blood pressure loading value (P ＜ 0.05).Binary logistic regression analysis indicated that the level of LDL,nighttime mean arterial pressure,the highest 24-hour diastolic blood pressure and nighttime systolic blood pressure standard deviation (NSBP-SD) were independent risk factors of WML.Conclusion Blood level,blood pressure variablity and diurnal rhythm of blood pressure are the important influencing factors of WML,among which increased NSBP-SD is the independent risk factor for WML.
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