高血压病人无症状性颅内动脉病变的危险因素探讨

目的:探讨高血压病人无症状性颅内动脉病变的危险因素。方法:收集245例住院高血压病患者,排除合并中风或中风历史、糖尿病及其他颅内疾病患者。以经颅多普勒超声(TCD)检查动脉异常作为反映颅内动脉病变的指标,观察年龄、高血压病程、血脂代谢和血尿酸水平对颅内动脉病变的影响。结果:老年高血压患者总颅内动脉异常率和血速增快率(20 14%,13 50%)明显高于非老年组(13 34%,7 48%,各P<0 001),而两组间血速减慢率无差别。老年组各单一动脉异常率均较非老年组高,其中大脑中动脉、椎动脉之间差异有显著性(P<0 05)。病程超过10年的患者总颅内动脉异常率及颈内动脉系各动脉异常率明显增加(各P<0 01),但椎基底动脉系各动脉异常率增加不明显。Logistic回归分析显示甘油三脂(OR3 398,95%CI:1 211-7 831)、高血压病程(OR1 671,95%CI:1 063-3 327)、年龄(OR1 235,95%CI:1 023-1 640)和高血压病人颅内动脉异常密切相关(各P<0 05)。结论:年龄、高血压病程和甘油三脂是高血压病人无症状性颅内动脉病变的独立危险因素。

Risk factors for asymptomatic intracranial arterial lesions in patients with hypertension

Aim: To elucidate risk factors for asymptomatic intracranial arterial lesions in patients with hypertension. Methods: Two hundreds and forty-five patients with hypertension were included. Exclusive criteria were stroke, stroke history, other intracranial diseases and diabetes mellitus. Intracranial arterial lesions was evaluated with transcranial Doppler sonography (TCD). Results: The prevalence of abnormal arteries (mainly the stenoses) in senile hypertension patients was greater than that in non-senile (20.14% vs 13.34%, P<0.001). Each artery checked showed higher abnormality rate in senile than in non-senile patients, especially the stenoses in middle cerebral artery and the decreased blood flow velocity in vertebral artery (P<0.05). When hypertension duration exceeded more than 10 years, main arteries of internal carotid artery system, showed greater abnormal prevalence (P<0.01), but the increase in abnormality rate of vertebrobasilar arterial system was not significant. Logistic regression analyses demonstrated that the intracranial arterial lesion was correlated to blood level of triglyceride (OR 3.398, 95% CI: 1.211-7.831), duration of hypertension (OR 1.671, 95% CI: 1.063-3.327) and age (OR 1.235, 95% CI: 1.023-1.640), (P<0.05). Conclusions: Age, hypertension duration and blood triglyceride level are independent risk factors for asymptomatic intracranial arterial lesions in patients with hypertension.