| Objective:the ventrolateral medulla (VLM) because the artery pulsatile compression possibly causes the blood pressure center of regulation function disorder to cause essential hypertension (EHTN), we studied the The relationship between ventrolateral medulla department of arterial pulsatile compression and essential hypertension, under the premise to control other risk factors in essential hypertension, to observed ventrolateral medulla department of arterial pulsatile compress and essential hypertension whether has the relevance, on the one hand, to develop ideas for the treatment of hypertension, in order to find better methods of treatment of hypertension, on the other hand to provide the corresponding theory basis for microvascular decompression surgery for patients with hypertension.Methods:This article uses the cross-section research technique, continuous collection of form May1,2011to February29,2012in the Tianjin Huanhu Hospital treatment, and with the head nuclear magnetic resonance image, formation inspection patient’s clinical material is2533cases, According to the inclusion and exclusion criteria, ultimately selected the number of454cases, collect and reorganize the relevant clinical data, and to understand the imaging features of all patients. With reference to the definition of hypertension 《Hypertension Prevention Guide》 in2005: in the case of antihypertensive drugs is not to use:systolic blood pressure≥140mmHg and/or diastolic blood pressure≥90mm Hg; In addition, if the patient is using antihypertensive drugs, hospitalization blood pressure below140/90mmHg, also diagnosed as hypertensive.454patients is divided into hypertension group and normal control group, and record the relevant clinical data and inspection data including: patient age, gender, systolic blood pressure, diastolic blood pressure, history of hypertension, C-response protein, blood glucose, history of diabetes, glycosylatedhemoglobin, serum creatinine, total cholesterol, triglycerides, high density lipoprotein, low density lipoprotein uric acid fifteen factors. Simultaneously records of the head magnetic resonance imaging (MRI) imaging data of all patients, joint analysis of magnetic resonance imaging data of all patients by an experienced diagnostic imaging physician and a chief physician, according to the relationship of the nerves, blood vessels and divides into without the oppression and has the oppression. For the disagreement of the image results from diagnostic imaging physician with the chief physician to make a final diagnosis, and obtain the final result.All data applications independent samples t test, chi-square test, statistical test methods for the statistics to understand the relationship of various factors with essential hypertension, and further under the control of risk factors associated with the use of multivariate logistic regression method (sle=0.10, sls=0.15), looking for the ventrolateral medulla arterial pulsatile compression is an independent risk factor for essential hypertension. The statistical analysis software SPSS17.0software, and take P≤0.05as statistics difference standard.Results:1.290cases of men and164cases of women were included in this study..Its age is18-91years old, the average age is61±12.42the year old.The head magnetic resonance imaging were found in335(73.78%)of hospitalized patients, ventrolateral medulla there are unilateral and (or) the bilateral neurovascular compression.2. The VLM existence of neurovascular compression in patients in this study of335cases, of which the left side of230(68.66%) cases, the right side of62(18.51%) cases, bilateral43(12.83%) cases. In addition, in the left side the VLM neurovascular compression of the patients, the responsibility vascular is vertebral artery in196cases, posterior inferior cerebellar artery in74cases,3cases of anterior inferior cerebellar artery. In the right side the VLM neurovascular compression of the patients, the responsibility of vessels is vertebral artery in85cases, posterior inferior cerebellar artery in19cases, anterior inferior cerebellar artery in1cases; bilateral VLM neurovascular compression in patients,33cases of responsibility for the vessels of the vertebral artery, two cases of posterior inferior cerebellar artery,0cases of anterior inferior cerebellar artery.3. According to the grading standards of hypertension, three different levels in patients with hypertension:1level:76cases, in which VLM neurovascular compression62in cases (81.57%),2level:77cases in which the VLM of neurovascular compression in66cases (85.71%),3level140cases, in which the VLM of neurovascular compression in122cases (87.14%) 4. The hypertensive patients in this study is293cases,161cases of patients with normal blood pressure, In the hypertension group, the patients with vascular compression of the left VLM is188cases, the positive rate of64.16%(188/293), the emergence of the right side of the VLM neurovascular compression in patients with34cases, the positive rate was11.60%(34/293). the emergence of the bilateral of the VLM neurovascular compression in patients with28cases, the positive rate was9.56%(28/293); normotensive control group, the left side of VLM neurovascular compression in patients for42cases, the positive rate was26.09%(42/161). right side of the VLM patients with neurovascular compression in28cases, the positive rate of17.39%(28/161), bilateral VLM with neurovascular compression in15cases, the positive rate of9.32%(15/161)5. The single factor analysis result: the size of the age, the level of total cholesterol, blood-fasting sugar level, the history of diabetes, glycosylated hemoglobin level and VLM left side of the existence of neurovascular compression on blood pressure was statistically significant between the hypertension group and control group the level (P<0.05). However C-response protein level, the level of serum creatinine, triglycerides, high-density lipoprotein level and low-density lipoprotein level no significant difference between the hypertensive and control groups (P>0.05).6. The systolic and diastolic blood pressure and VLM neurovascular compression carries on the bivariate correlation analysis, the result was systolic blood pressure and the left side of VLM neurovascular compression was positive correlation (R=0.303, P<0.001), while there was no correlation with neurovascular compression of the right side of the VLM (r=-0.026, P=.586). Similarly, diastolic blood pressure and the left side of VLM neurovascular compression was positive correlation.(R=.277, P<0.001), while the correlation with the right side of the VLM of neurovascular compression does not exist.(r=-0.042, P=0.375)7. Multi-factor Logistic gradually regression analysis showed that age, total cholesterol, vascular compression of the left VLM is an independent risk factor for essential hypertension. And view from the odds ratio (OR), the greater the age, the greater the risk for the patients with left side of the VLM of neurovascular compression population suffering from hypertensionConclusion:Essential hypertension is the most common clinical heart, blood vessel disease, its pathogenesis is still unclear, which part of the imaging performance of the ventrolateral medulla artery pulsating oppression, such oppression more than seen in the left side ventrolateral medulla. According to multi-factor Logistic gradually regression, the left side of VLM neurovascular compression as essential hypertension an independent risk factor. Therefore microvascular decompression may provide a new therapeutic approach for the existence of the left VLM nerve vascular compression, drug refractory essential hypertension patients. |
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