基于老年人群血压水平与脑部老化及认知功能相关性的大样本临床研究

At present our country has been going into the population aging society, physical damage and multiple complications that caused by hypertension have severely restricted the elderly population health status and quality of life. It consumes large amounts of medical and social resources. Our preliminary clinical study has found that the degree of brain aging in elderly is affected by the level of blood pressure. This project proposes to evaluate the level of brain aging and cognitive function by recruiting different blood pressure levels elderly population with antihypertensive drugs maintenance or not through MRI and cognitive assessment based on what they found. Taking sample survey based on sample size formula for statistical treatment, we will focus on the volume of the whole gray matter and white matter, brain iron content in basal ganglia, T2WI white matter hyperintensity, and white matter fiber tracts integrity level to evaluate the correlation with the level of high blood pressure. This study is expected to clarify the relationship between the level of hypertension in the elderly and braining aging with cognitive functions. In this study, we will firstly adopted the evaluation index of brain aging imaging to study mutuality between the degree of hypertension controling and brain aging systematically.Therefore, this research aims to provide a new way for prevention and treatment of hypertension injury and its complications.

目前我国已经步入人口老龄化社会，因高血压而引发的机体损伤以及多种并发症严重制约着老龄人群的健康水平和生活质量，消耗大量医疗和社会资源。我们前期临床研究发现老年人群的脑部老化程度与血压水平密切相关，在此基础上，本课题拟运用磁共振成像和认知评估表对药物干预与否的不同血压水平的老年人群脑部老化水平和认知功能进行检测和评估，采取抽样调查样本量公式进行统计学处理，通过全脑灰质和白质的体积、脑部基底核铁元素含量、脑白质T2WI高信号以及白质纤维束完整性水平等脑部老化评价指标与高血压水平的相关性研究，阐明老年人群高血压水平与脑老化和认知功能之间的关联程度，明确老年人群的高血压控制水平与脑部老化和认知功能之间的关系，本研究率先开展基于脑部老化的影像学评估指标系统性研究高血压控制程度与脑老化间相互性，旨在为临床老年高血压引发的身体损伤以及多种并发症的预防与诊疗提供一种新途径。

高血压是老年人常见病、多发病，因高血压引起的脑老化结构和功能改变的大样本研究尚未报道。本项目采用大鼠动物实验及大样本人群两部分进行研究。第一部分采用磁共振结构和功能成像和认知评估表对药物干预与否的不同血压水平的老年人群脑部影像学老化水平和认知功能进行检测和评估，研究发现（1）高血压用药后血压正常、高血压未用药、用药后血压偏高人群的脑灰质体积减少脑区主要位于双侧颞叶和双侧感觉运动区，脑灰质体积减少明显的脑区包括：右侧颞极及延伸脑区（左侧海马旁回、左侧岛盖部额下回、左侧额上回中部）；（2）高血压组伴轻度认知功能障碍人群脑网络仍然具有小世界属性；（3），高血压患者伴脑微出血发病率为35%，脑微出血严重程度与高血压程度正相关，同时，脑微出血是高血压患者认知状态下降的独立危险因素。第二部分对自发性高血压大鼠分别于10、24、52和80周进行纵向高分辨率磁共振成像扫描，确定了在高血压和衰老的联合作用下，间隔区、前扣带皮层、初级躯体感觉皮层、尾状核、海马和伏隔核体积变化呈倒u型轨迹。以上研究成果能为临床老年高血压引发的脑损伤的预防与诊疗提供可靠影像依据。