Fan Yangyi, Hou Chang, Peng Li, Gao Xuguang, Xu Yan
Department of Neurology, Peking University People's Hospital, Beijing, China.
Department of Cardiology, Peking University People's Hospital, Beijing, China.
Front Neurol. 2020 Sep 30;11:513067. doi: 10.3389/fneur.2020.513067. eCollection 2020.
Lacunar infarcts, white matter lesions, cerebral microbleed, enlarged perivascular space and brain atrophy are regarded as magnetic resonance imaging (MRI) manifestations of cerebral small vessel disease (cSVD). 24-hour blood pressure variability (BPV) has been reported to relate with cerebral small vessel disease, but the impact of 24-h BPV on the total MRI cSVD burden and its progression in inpatients with cerebrovascular disease has not been investigated yet. We enrolled inpatients with cerebrovascular disease, who underwent the 24-h ambulatory blood pressure monitoring (ABPM) and the brain MRI scan at baseline and had the follow-up brain MRI images stored in the clinical information system of our hospital. BPV was quantified by the calculation of standard deviation (SD), coefficient of variation (CV), weighted standard deviation (wSD) of blood pressure record. We evaluated the total cSVD score on baseline MRI and the MRI followed-up to obtain the total burden of cSVD. The cSVD burden progression was estimated through the comparison of the total cSVD score on the two MRIs. A total of 140 patients with an average age of 65.6 years were finally enrolled, 82.9% (116/140) of whom had one or more cSVD markers. After a median of 4.4 years follow-up, cSVD score progression were found in 50.7% (71/140) of the patients. Both SD and CV of SBP and DBP during 24-h and daytime as well as the SBP wSD differed significantly among different total cSVD score groups. The SBP SD and CV during 24-h and daytime, the SBP SD in nighttime, the DBP SD and CV during the daytime were significantly higher in the cSVD progression group than those in the cSVD no-progression group. The SBP wSD and the DBP wSD were significantly higher in the cSVD progression group than those in the cSVD no-progression group. Logistic regression analyses revealed that daytime SBP SD and SBP wSD were independent risk factors for total cSVD burden [daytime SBP SD: OR = 1.628, 95% CI = 1.105-2.398 (per 5 mmHg increase in SD), = 0.014; SBP wSD: OR = 2.248, 95% CI = 1.564-3.230 (per 5 mmHg increase in wSD), < 0.001)] and SBP wSD was a significant predictor for cSVD progression [OR = 2.990, 95% CI = 1.053-8.496 (per 5 mmHg increase in wSD), = 0.040]. Higher BPV were significantly related with total cSVD burden in inpatients with cerebrovascular disease. SBP SD during daytime and SBP wSD were independent risk factor for total cSVD burden and SBP wSD was an predictive factor for cSVD progression.
腔隙性梗死、白质病变、脑微出血、血管周围间隙增宽和脑萎缩被视为脑小血管病（cSVD）的磁共振成像（MRI）表现。据报道，24小时血压变异性（BPV）与脑小血管病有关，但24小时BPV对脑血管病住院患者的MRI总体cSVD负担及其进展的影响尚未得到研究。我们纳入了脑血管病住院患者，这些患者在基线时接受了24小时动态血压监测（ABPM）和脑部MRI扫描，且后续脑部MRI图像存储在我院临床信息系统中。通过计算血压记录的标准差（SD）、变异系数（CV）、加权标准差（wSD）对BPV进行量化。我们评估了基线MRI上的总体cSVD评分以及随访MRI，以获得cSVD的总体负担。通过比较两次MRI上的总体cSVD评分来估计cSVD负担进展情况。最终共纳入140例平均年龄为65.6岁的患者，其中82.9%（116/140）有一个或多个cSVD标志物。经过中位4.4年的随访，发现50.7%（71/140）的患者cSVD评分有进展。不同总体cSVD评分组在24小时和白天期间收缩压（SBP）和舒张压（DBP）的SD和CV以及SBP的wSD差异均有统计学意义。cSVD进展组24小时和白天期间的SBP SD和CV、夜间SBP SD、白天DBP SD和CV均显著高于cSVD无进展组。cSVD进展组的SBP wSD和DBP wSD显著高于cSVD无进展组。Logistic回归分析显示，白天SBP SD和SBP wSD是总体cSVD负担的独立危险因素[白天SBP SD：比值比（OR）=1.628，95%置信区间（CI）=1.105 - 2.398（SD每增加5 mmHg），P = 0.014；SBP wSD：OR = 2.248, 95% CI = 1.564 - 3.230（wSD每增加5 mmHg），P < 0.001]，且SBP wSD是cSVD进展的显著预测因素[OR = 2.990, 95% CI = 1.053 - 8.496（wSD每增加5 mmHg），P = 0.040]。较高的BPV与脑血管病住院患者的总体cSVD负担显著相关。白天SBP SD和SBP wSD是总体cSVD负担的独立危险因素，SBP wSD是cSVD进展的预测因素。
