2019 年第 9 期 第 14 卷

分层血压控制对脑小血管病患者认知功能障碍的影响

Effect of stratified blood pressure control on cognitive dysfunction in patients with cerebral small vessel disease

作者：王琳李凡舒俊龙王丽黄一宁

英文作者：

单位：100034北京大学第一医院神经内科（王琳为北京市和平里医院神经内科进修生）

英文单位：

关键词：脑小血管病；分层血压控制；脑白质变性；简易精神状态检查量表；蒙特利尔认知评估量表

英文关键词：

• 摘要：

• 【摘要】目的    探讨分层血压控制对脑小血管病患者认知功能障碍的影响。方法    选取2013年10月至2015年1月北京大学第一医院神经内科门诊及住院的脑小血管病合并高血压患者56例，完全随机分为强化降压组（目标血压：收缩压100～129 mmHg）（1 mmHg=0.133 kPa）和标准降压组（目标血压：收缩压130～139 mmHg），调整降压药物剂量使血压降至目标水平，随访观察2年。入组时和2年后采用简易精神状态量表(MMSE)和蒙特利尔认知评估量表(MoCA)评估认知功能，行头颅磁共振成像评估腔隙性脑梗死(LI)和脑白质变性(WML)。结果    2年后随访，强化降压组20例患者均达到目标血压；标准降压组26例患者中17例达到目标血压（标准降压组1），9例达到强化降压组目标血压（标准降压组2）。强化降压组、标准降压组2的MMSE评分、MoCA评分与入组时比较差异均无统计学意义(均P＞0.05)；标准降压组1的MMSE评分、MoCA评分明显低于入组时［（26.9±2.8）分比（27.5±2.2）分、（22.4±3.4）分比（23.4±3.9）分］，差异均有统计学意义(均P＜0.05）；强化降压组、标准降压组1及组2的LI评分与入组时比较差异均无统计学意义(均P＞0.05）；强化降压组、标准降压组2的WML评分与入组时比较差异无统计学意义(P＞0.05）；标准降压组1的WML评分明显高于入组时［（5.0±1.6）分比（4.8±1.4）分］，差异有统计学意义(P＝0.02）。多因素Logistic回归分析显示，WML评分（比值比＝3.38，95%置信区间：3.12～8.41，P＝0.008）、年龄（比值比＝2.95，95%置信区间：2.72～6.08，P＝0.028）、收缩压（比值比＝1.89，95%置信区间：1.68～5.46，P＝0.026）、LI评分（比值比＝1.84，95%置信区间：1.61～8.20，P＝0.025）是MMSE评分的影响因素。结论    强化血压控制可延缓脑小血管病患者认知功能损害。

• 【Abstract】Objective    To investigate the effect of stratified blood pressure control on cognitive dysfunction in patients with cerebral small vessel disease. Methods    Fifty-six patients with cerebral small vessel disease complicated with hypertension admitted to Peking University First Hospital between October 2013 and January 2015 were randomly divided into enhanced anti-hypertension group(target systolic pressure 100-129 mmHg) and standard anti-hypertension group(target systolic pressure 130-139 mmHg). Antihypertensive drugs and doses were adjusted to achieve the target blood pressure. All patients were followed for 2 years. Cognitive function was assessed by Mini-Mental State Examination(MMSE) and Montreal Cognitive Assessment(MoCA). Lacunar infarction(LI) and white matter lesion(WML) were observed by cranial magnetic resonance imaging. Results    After 2-year follow-up, 20 patients in enhanced anti-hypertension group reached the target blood pressure; in standard anti-hypertension group（26 patients）, 17 patients reached the target blood pressure（130-139 mmHg, standard anti-hypertension group 1） and 9 patients reached 100-129 mmHg(standard anti-hypertension group 2). MMSE and MoCA scores showed no significant changes in enhanced anti-hypertension group and standard anti-hypertension group 2(P＞0.05); MMSE and MoCA scores in standard anti-hypertension group 1 were significantly lower than those before treatment［（26.9±2.8） vs （27.5±2.2）, （22.4±3.4） vs （23.4±3.9）］(both P＜0.05）. There was no significant change of LI score in enhanced anti-hypertension group and standard anti-hypertension group 1, 2; WML score in enhanced anti-hypertension group and standard anti-hypertension group 2 showed no significant change; WML score after 2-year follow-up in standard anti-hypertension group 1 was significantly higher than that before treatment［（5.0±1.6） vs （4.8±1.4）］(P＝0.02）. Multivariate logistic regression showed that WML score（odds ratio＝3.38， 95% confidence interval： 3.12-8.41， P＝0.008）, age（odds ratio＝2.95， 95% confidence interval： 2.72-6.08， P＝0.028）, systolic blood pressure（odds ratio＝1.89， 95% confidence interval： 1.68-5.46， P＝0.026） and LI score（odds ratio＝1.84， 95% confidence interval： 1.61-8.20， P＝0.025） were influence factors of MMSE score. Conclusion    Enhanced blood pressure control can delay the cognitive impairment in patients with cerebral small vessel disease.