作者：张晓倩，刘思睿，刘朝曦，范晓媛，侯波，有慧，朱以诚，马超，冯逢

单位：

1.中国医学科学院北京协和医学院北京协和医院放射科2.中国医学科学院北京协和医学院北京协和医院神经内科3.中国医学科学院基础医学研究所北京协和医学院基础学院人体解剖与组胚学系4.中国医学科学院北京协和医学院北京协和医院疑难重症及罕见病国家重点实验室

单位（英文）：

Department of Radiology, Chinese Academy of Medical Sciences/Peking Union Medical College/Peking Union Medical College Hospital;Department of Neurology, Chinese Academy of Medical Sciences/Peking Union Medical College/Peking Union Medical College Hospital;Institute of Basic Medical Sciences Chinese Academy of Medical Sciences/Department of Human Anatomy, Histology and Embryology, School of Basic Medicine, Peking Union Medical College;State Key Laboratory of Difficult, Severe and Rare Diseases, Chinese Academy of Medical Sciences/Peking Union Medical College/Peking Union Medical College Hospital;

关键词：

H型高血压; 大脑小血管疾病; 高同型半胱氨酸血症; 影响因素分析;

关键词（英文）：

H-type hypertension;Cerebral small vessel diseases;Hyperhomocysteinemia;Root cause analysis;

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2022.00.313

基金项目：

国家自然科学基金资助项目（82071899）； 医科院创新工程项目（CIFMS 2021-I2M-1-025）；

摘要：

目的 探讨H型高血压与脑小血管病（CSVD）总负荷及10年卒中发病风险的相关性。方法 回顾性选取2017年5月至2021年5月于北京协和医院参与遗体捐献队列研究的受试者376例，根据是否合并高血压和高同型半胱氨酸血症（HHcy）将其分为H型高血压组50例、单纯HHcy组58例、单纯高血压组143例和对照组125例。收集受试者的临床资料、影像学检查指标，采用MRI评估CSVD总负荷，采用改良版Framingham卒中危险评分量表（mFSP）评估10年卒中发病风险。比较四组临床资料、影像学检查指标、CSVD总负荷为重度者占比及10年卒中发病风险，采用单因素及多因素Logistic回归分析探讨CSVD总负荷的影响因素，采用多元线性回归分析探讨10年卒中发病风险的影响因素。结果 四组年龄、男性占比、有吸烟史者占比、有饮酒史者占比、有糖尿病史者占比、有心房颤动史者占比、收缩压（SBP）、舒张压（DBP）、TC、HDL-C、同型半胱氨酸（Hcy）、维生素B12、侧脑室旁脑白质高信号（WMHs）Fazekas量表评分为3分者占比、脑深部WMHs Fazekas量表评分≥2分者占比、中重度WMHs检出率、血管周围间隙（PVSs）>10个者占比、腔隙灶检出率、CSVD总负荷为重度者占比、10年卒中发病风险比较，差异有统计学意义（P<0.05）。单因素Logistic回归分析结果显示，年龄、性别、吸烟史、SBP和H型高血压是CSVD总负荷的影响因素（P<0.05）；多因素Logistic回归分析结果显示，年龄、吸烟史和H型高血压是CSVD总负荷的独立影响因素（P<0.05）。多元线性回归分析结果显示，年龄、性别、吸烟史、饮酒史、糖尿病史、心房颤动史、心血管病史、左心室肥厚史及合并高血压和HHcy情况是10年卒中发病风险的独立影响因素（P<0.05）。结论 H型高血压患者影像学检查指标异常检出率、CSVD总负荷、10年卒中发病风险升高，H型高血压是CSVD总负荷及10年卒中发病风险的独立影响因素。

英文摘要：

Objective To investigate the relationship between H-type hypertension and cerebral small vessel disease（CSVD） total burden and 10-year stroke risk. Methods A total of 376 subjects who participated in the cadaver donation cohort study from May 2017 to May 2021 in the Peking Union Medical College Hospital were retrospectively selected and divided into H-type hypertension group（50 cases）, isolated hyperhomocysteinemia（HHcy） group（58 cases）, isolated hypertension group（143 cases） and control group（125 cases） according to whether combined with hypertension and/or HHcy. The clinical data and imaging examination indexes were collected. CSVD total burden was assessed by MRI, and 10-year stroke risk was assessed by the modified Framingham Stroke Profile（mFSP）. The clinical data, imaging examination indexes, the proportion of severe CSVD total burden and 10-year stroke risk were compared among the four groups. Univariate and multivariate Logistic regression analysis were used to explore the influencing factors of CSVD total burden, and multiple linear regression analysis was used to explore the influencing factors of 10-year stroke risk. Results There were significant differences in age, the proportion of male, smoking history, drinking history, diabetes history and atrial fibrillation history, systolic blood pressure（SBP）, diastolic blood pressure（DBP）, TC, HDL-C, homocysteine（Hcy）, vitamin B12, the proportion of lateral ventricle white matter hyperintensities（WMHs） Fazekas Scale score=3, the proportion of deep brain WMHs Fazekas Scale score ≥ 2, detection rate of medium and severe WMHs, the proportion of perivascular spaces（PVSs） > 10, detection rate of lacunae focuses, the proportion of severe CSVD total burden and 10-year stroke risk among the four groups（P < 0.05）. Univariate Logistic regression analysis showed that age, gender, smoking history, SBP and H-type hypertension were the influencing factors of CSVD total burden（P < 0.05）. Multivariate Logistic regression analysis showed that age, smoking history and H-type hypertension were the independent influencing factors of CSVD total burden（P < 0.05）. Multiple linear regression analysis showed that age, gender, smoking history, drinking history, diabetes history, atrial fibrillation history, cardiovascular history, left ventricular hypertrophy history and combined with hypertension and/or HHcy were the independent influencing factors of 10-year stroke risk（P < 0.05）. Conclusion The detection rates of abnormal imaging examination indexes, CSVD total burden and 10-year stroke risk are increased in patients with H-type hypertension. H-type hypertension is an independent influencing factor of CSVD total burden and 10-year stroke risk.

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