| Objective: White matter ischemic lesions(WMLs)is one of the signs of cerebral small vessel disease.With the aging of the population,the importance of WMLs has become increasingly prominent.However,there are still some controversies about the correlation between different parameters of 24 h ambulatory blood pressure monitoring(24h ABPM)and the severity of WMLs.This study aims to investigate the correlation between different parameters of 24 h ABPM and the severity of WMLs in people over the age of 45,then provide a new evidence for the clinical prevention of white matter lesionsMethods: We made a cross-sectional study on patients who were indicated with WMLs through head MRI and then finished 24 h ABPM during the period when they hospitalized in the neurology department of the People’s Hospital of Liaoning Province from September,2016 to October,2018.WMLs were quantified using the modified Scheltens scale which is a semiquantative rating scale.Periventricular white matter lesions(PVWML)and deep white matter lesions(DWML)were assessed by the scale,and the sum of the two was used as the overall severity score of WMLs.Included patients were divided into 3 groups according to the total WMLs scores tertiles.Use SPSS Chinese software package to process statistical analyses.Multivariate ordinal logistic regression analysis was used to investigate independent risk factors affecting overall WMLs scores.Multivariate linear regression analysis was used to investigate the influencing factors of PVWML and DWML scores.Results: A total of 201 patients were enrolled,aged(62.7±10.3)years(range 45-88years),82 males(40.8%),and 123 patients(61.2%)with hypertension.The scores of PVWML,DWML and total WMLs in hypertension group were significantly higher than those in non-hypertension group(P < 0.05).The total WMLs scores were 1 ~ 27.According to the tertiles,64 patients(31.8%)were divided into the lowest tertile group(1~3),65(32.3%)in the middle tertile group(4~8),and 72(35.8%)in the highest tertile group(9~27).There were significant differences in PVWML,DWML and total WMLs scores among the three groups(all P<0.001).There was significant difference in age between any two WMLs score groups,namely,the highest tertile group > middle tertile group > the lowest tertile group(69.5±8.5 years vs.63.1±9.2 years vs.54.5±6.9 years;all P<0.001).The proportion of hypertension in the middle tertile group(66.2%)and the highest tertile group(69.4%)were significantly higher than those in the lowest tertile group(46.9%;all P<0.05).The homocysteine in the highest tertile group was significantly higher than that in the lowest tertile group(P<0.05).In terms of 24 h ABPM parameters,the 24 h mean systolic blood pressure(24h SBP)in the highest tertile group was higher than that in the lowest tertile group,and the nighttime mean systolic blood pressure(n SBP)level in the highest tertile group was higher than that in the lowest and middle tertile groups,the SD of daytime systolic blood pressure(d SBPSD)and the SD of the nighttime systolic blood pressure(n SBPSD)in the highest tertile group were higher than those in the lowest tertile group,and d SBPSD of the middle tertile group was higher than of the lowest tertile group.The above differences were statistically significant(all P<0.05).Multivariate ordinal logistic regression analyses showed that the level of age(OR1.143,95% CI 1.104~1.185,P<0.001),24 h SBP(OR 1.026,95% CI 1.005~1.048,P=0.015),d SBP(OR 1.022,95% CI 1.001~1.043,P=0.036),n SBP(OR 1.026,95% CI1.006~1.046,P=0.011),d SBPSD(OR 1.119,95% CI 1.023~1.221,P=0.013)and n SBPSD(OR 1.107,95% CI 1.022 ~ 1.200,P=0.013)were independently positive associated with the total WMLs scores.Multivariate linear regression analyses showed that the level of age [standardized regressive coefficient(β)=0.607,95%CI 0.500 ~0.714,P<0.001],24 h SBP(β=0.182,95%CI 0.075~0.289,P=0.001),d SBP(β=0.156,95%CI 0.049~0.264,P=0.004)and n SBP(β=0.200,95%CI 0.092~0.307,P<0.001)were independent influencing factors of the PVWML score,and the level of age(β=0.505,95%CI 0.387~0.622,P<0.001),24 h SBP(β=0.132,95%CI 0.015~0.248,P=0.027)、d SBP(β=0.127,95%CI 0.011~0.243,P=0.032),n SBP(β=0.148,95% CI0.031~0.265,P=0.013)and n SBPSD(β=0.133,95%CI 0.016~0.250,P=0.027)were independent influencing factors of the DWML score.Conclusion: 1.The level of age,24 hSBP,dSBP,nSBP,dSBPSD and nSBPSD maybe independent risk factors affecting the severity of WMLs.2.Compared with DBP,the level and variability of SBP are more closely related to the severity of WMLs.3.The effects of 24 h dynamic blood pressure on PVWML and DWML were similar. |
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