【目的】 探讨老年高血压性脑小血管病患者的血压特点及其与中医证型的相关性。【方法】 采用回顾性分析方法，纳入 老年原发性高血压患者189例，根据是否患有脑小血管病将患者分为脑小血管病组87例和非脑小血管病组102例。收集2组 患者的血压相关检查参数及中医临床四诊资料，运用统计学方法分析血压特点及其与中医证型之间的相关性。【结果】（1）动 态血压参数：脑小血管病组患者的24 h平均收缩压（24hSBP）、24 h平均舒张压（24hDBP）、日间平均收缩压（DSBP）、日间平 均舒张压（DDBP）、夜间平均收缩压（NSBP）、夜间平均舒张压（NDBP）、24 h平均脉压（24hPP）、日间平均脉压（DPP）、夜间 平均脉压（NPP）、最高收缩压、清晨收缩压、日间收缩压负荷值及夜间收缩压负荷值的平均值均高于非脑小血管病组（P＜ 0.01）。（2）血压变异性：脑小血管病组患者的夜间收缩压标准差（NSSD）平均值高于非脑小血管病组（P＜0.01）。（3）血压昼夜节 律：2组患者的动态血压昼夜节律比较，差异有统计学意义（P＜0.05）。其中，非脑小血管病组以非杓型（50例，49.02%）和 杓型（31例，30.39%）为主，而脑小血管病组以非杓型（38例，43.68%）和超杓型（31例，35.63%）为主。（4）Logistic回归分析结 果显示：24hSBP（OR = 1.296，95%CI：1.112 ~ 1.511）、最高收缩压（OR = 1.074，95%CI：1.006～1.146）、清晨收缩压（OR = 1.064，95%CI：1.013 ~ 1.118）、异常血压昼夜节律（OR = 3.736，95%CI：1.663～8.390）是脑小血管病的相关影响因素（P＜ 0.05或 P＜0.01）。（5）中医证型分布：非脑小血管病组以痰湿壅盛证（58.82%）、阴虚阳亢证（21.57%）为主，脑小血管病组以 阴虚阳亢证（51.72%）、痰湿壅盛证（21.84%）为主。（6）不同证型的血压特点：痰湿壅盛证脑小血管病组的DPP显著高于非脑 小血管病组（P＜0.01），阴虚阳亢证脑小血管病组的 24hDBP、NDBP 显著高于非脑小血管病组（P＜0.01）。【结论】 24hSBP、 最高收缩压、清晨收缩压水平升高以及异常血压昼夜节律可能是导致老年高血压性脑小血管病发病的重要危险因素。痰湿 壅盛型老年高血压患者更应关注日间平均脉压水平，阴虚阳亢型老年高血压患者更应注重舒张压水平的监测。老年高血压 患者应动态观察血压各项相关指标，早期有效调控血压有助于脑小血管病的防治。

Objective To explore the characteristics of blood pressure in the elderly patients with hypertensive cerebral small vessel disease（CSVD）and their correlation with traditional Chinese medicine（TCM）syndrome types. Methods A retrospective analysis was conducted in 189 elderly patients with essential hypertension. With reference to the presence or absence of CSVD，the patients were divided into CSVD group（87 cases）and nonCSVD group（102 cases）. The blood pressure related parameters and clinical data obtained by four diagnostic methods of TCM in the two groups were collected， and then the characteristics of blood pressure and their correlation with TCM syndromes were analyzed with statistical methods. Results（1）CSVD group had higher values than non-CSVD group in the ambulatory blood pressure parameters of 24-hour systolic blood pressure（24hSBP）， 24-hour diastolic blood pressure（24hDBP），daytime systolic blood pressure（DSBP），daytime diastolic blood pressure（DDBP）， nighttime systolic blood pressure（NSBP）， nighttime diastolic blood pressure（NDBP）， 24-hour pulse pressure（24hPP），daytime pulse pressure（DPP），nighttime pulse pressure（NPP），maximum SBP，morning SBP，daytime SBP load and nighttime SBP load（P＜0.01）.（2）The analysis of blood pressure variability showed that the mean value of nighttime SBP standard deviation（NSSD）in CSVD group was higher than that in the non-CSVD group（P＜0.01）.（3）The analysis of circadian rhythm of blood pressure showed that there was significant difference in the comparison of circadian rhythm of ambulatory blood pressure between the two groups（P＜0.05）：non-CSVD group was predominated by non-dipper type blood pressure（50 cases，49.02%） and dipper type blood pressure（31 cases，30.39%），and CSVD group was predominated by non-dipper type blood pressure（38 cases， 43.68%）and super-dipper type blood pressure（31 cases， 35.63%）.（4）Logistic regression analysis showed that 24hSBP（OR = 1.296， 95% CI： 1.112-1.511）， maximum SBP（OR=1.074， 95%CI： 1.006-1.146）， morning SBP（OR = 1.064， 95%CI： 1.013-1.118）， abnormal circadian rhythm of blood pressure（OR = 3.736，95% CI：1.663-8.390）were the influence factors of CSVD（P＜0.05 or P＜0.01）. （5）The analysis of the distribution of TCM syndrome types showed that non-CSVD group was dominated by accumulation of excess phlegm-damp syndrome（58.82%）and yin deficiency and yang hyperactivity syndrome （21.57%），and CSVD group was dominated by yin deficiency and yang hyperactivity syndrome（51.72%）and accumulation of excess phlegm-damp syndrome（21.84%）.（6）The analysis of blood pressure in patients with various syndrome types showed that the DPP of patients with accumulation of excess phlegm-damp syndrome in the CSVD group was significantly higher than that in the non- CSVD group（P＜0.01），and the 24hDBP and NDBP of patients with yin deficiency and yang hyperactivity syndrome in the CSVD group were significantly higher than those in the non-CSVD group（P＜0.01）. Conclusion It is indicated that 24hSBP， maximum SBP， elevated morning SBP， and abnormal blood pressure circadian rhythms may be the important risk factors for the hypertensive CSVD in the elderly. Elderly hypertensive patients with accumulation of excess phlegm-damp syndrome should pay more attention to the mean daytime pulse pressure，and elderly hypertensive patients with yin deficiency and yang hyperactivity syndrome should pay more attention to monitoring DBP. The dynamic observation and early control of the blood pressure is helpful for the prevention and treatment of CSVD in the elderly patients with hypertension.

R259.441；R277.7

广东省东莞市社会发展科技计划项目（编号：20231800940002）