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目的研究高血压患者脑白质病变程度与直立性低血压(OH)的关系。方法选择2014年3月至2015年1月在西安交通大学第一附属医院神经内科及心内科门诊、住院的经过磁共振成像检查无脑卒中的原发性高血压患者。测量卧位、立位血压,以卧位转为立位3min内收缩压下降≥20和(或)舒张压下降≥10mm Hg为OH。使用Fazekas量表评估脑白质病变,其中0~3分为无/轻度脑白质病变,4~6分为重度脑白质病变。结果患者225例重度脑白质病变59例(26.2%),符合OH标准49例(21.8%)。OH组重度脑白质病变发生率高于非OH组(51.0%比19.3%,P<0.01)。OH组脑白质病变评分高于非OH组(3.67±1.03比2.55±1.27,P<0.05)。多因素分析显示,与脑白质病变相关的因素有:年龄(OR=3.347,95%CI 1.140~9.833,P=0.028)、高血压病程(OR=1.121,95%CI1.064~1.181,P<0.001)、卧位舒张压(1.059,95%CI 1.015~1.105,P=0.008)和OH(OR=3.637,95%CI1.539~8.590,P=0.003)。结论 OH与高血压患者脑白质病变呈正相关,OH可能是高血压促进脑白质病变的机制之一。
Objective To investigate the relationship between white matter lesions and orthostatic hypotension (OH) in hypertensive patients. Methods From March 2014 to January 2015, patients with essential hypertension without stroke were examined by magnetic resonance imaging in the Department of Neurology and Cardiology of the First Affiliated Hospital of Xi’an Jiaotong University. Measurement of lying position, standing position blood pressure, lying position to stand up within 3min systolic blood pressure drop ≥20 and (or) diastolic blood pressure drop ≥10mm Hg OH. White matter lesions were assessed using the Fazekas scale, 0 to 3 for no / mild white matter lesions and 4 to 6 for severe white matter lesions. Results A total of 225 patients with severe white matter lesions (59 cases, 26.2%) met the OH criteria in 49 cases (21.8%). The incidence of severe white matter lesions in OH group was higher than that in non-OH group (51.0% vs. 19.3%, P <0.01). The score of white matter lesions in OH group was higher than that in non-OH group (3.67 ± 1.03 vs 2.55 ± 1.27, P <0.05). Multivariate analysis showed that the factors associated with leukodystrophy were age (OR = 3.347,95% CI 1.140-9.833, P = 0.028), duration of hypertension (OR = 1.121,95% CI1.064-1.181, P < 0.001), supine diastolic pressure (1.059, 95% CI 1.015-1.105, P = 0.008) and OH (OR = 3.637, 95% CI 1.539-8.590, P = 0.003). Conclusions OH is positively correlated with white matter lesion in hypertensive patients, and OH may be one of the mechanisms of hypertension in promoting white matter lesion.