Chen Xin, Zhu Yingqian, Geng Shasha, Li Qingqing, Jiang Hua
Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
Front Aging Neurosci. 2019 Aug 6;11:192. doi: 10.3389/fnagi.2019.00192. eCollection 2019.
: Ambulatory blood pressure variability (ABPV), ABP, and carotid intima-media thickness (IMT) are closely associated with white matter hyperintensities (WMH), and few studies focused on establishing effective models based on ABP, ABPV, and IMT to predict the WMH burden. We aimed to evaluate the value of a predictive model based on the metrics of ABP, ABPV, and IMT, which were independently associated with the WMH burden. : We retrospectively enrolled 140 hypertensive inpatients for physical examinations in Shanghai East Hospital, Tongji University School of Medicine between February 2018 and January 2019. The basic clinical information of all subjects was recorded, and we also collected the metrics of ABP, ABPV, and IMT. Patients with Fazekas scale grade ≥2 were classified into heavy burden of WMH group. Then, we analyzed the association between all characteristics and the WMH burden. Multivariate analysis was performed to assess whether the metrics of ABP, ABPV, and IMT were independently associated with WMH, and we used receiver operating characteristic (ROC) to evaluate the value of predictive model based on the metrics of ABP, ABPV, and IMT. : Higher WMH grade was associated with increasing age, diabetes mellitus, higher total cholesterol (TC), higher low-density lipoprotein (LDL), higher IMT, higher 24-h systolic blood pressure (SBP), higher daytime SBP, higher nocturnal SBP, 24-h and daytime standard deviation (SD) of SBP, and 24-h SBP weight SD; 24-h SBP, 24-h SBP-SD, and IMT were independently related to the burden of WMH even after adjusting for the clinical variables. In addition, we also established a model that has a higher predictive capacity using 24-h SBP, 24-h SBP-SD, and IMT in the ROC analysis to assess the WMH burden in hypertensive patients. : Higher 24-h SBP, higher 24-h SBP-SD, and larger IMT were independently associated with a greater burden of WMH among elderly primary hypertension Asian patients. Establishing a model based on these factors might provide a new approach for enhancing the accuracy of diagnosis of WMH using metrics in 24-h ABPM and carotid ultrasound.
动态血压变异性（ABPV）、动态血压（ABP）和颈动脉内膜中层厚度（IMT）与脑白质高信号（WMH）密切相关，而很少有研究致力于基于ABP、ABPV和IMT建立有效模型来预测WMH负担。我们旨在评估基于ABP、ABPV和IMT指标的预测模型的价值，这些指标与WMH负担独立相关。我们回顾性纳入了2018年2月至2019年1月期间在同济大学医学院附属上海东方医院进行体检的140例高血压住院患者。记录了所有受试者的基本临床信息，我们还收集了ABP、ABPV和IMT指标。Fazekas量表分级≥2级的患者被归入WMH高负担组。然后，我们分析了所有特征与WMH负担之间的关联。进行多变量分析以评估ABP、ABPV和IMT指标是否与WMH独立相关，并且我们使用受试者工作特征（ROC）曲线来评估基于ABP、ABPV和IMT指标的预测模型的价值。较高的WMH分级与年龄增加、糖尿病、总胆固醇（TC）升高、低密度脂蛋白（LDL）升高、IMT升高、24小时收缩压（SBP）升高、日间SBP升高、夜间SBP升高、24小时和日间SBP标准差（SD）以及24小时SBP加权SD相关；即使在调整临床变量后，24小时SBP、24小时SBP-SD和IMT仍与WMH负担独立相关。此外，我们还在ROC分析中使用24小时SBP、24小时SBP-SD和IMT建立了一个具有更高预测能力的模型，以评估高血压患者的WMH负担。在老年亚洲原发性高血压患者中，较高的24小时SBP、较高的24小时SBP-SD和较大的IMT与更大的WMH负担独立相关。基于这些因素建立模型可能为提高使用24小时动态血压监测和颈动脉超声指标诊断WMH的准确性提供一种新方法。
