血脂、肾小球滤过率和颈动脉斑块与脑小血管病相关性的多因素分析研究

目的 分析血脂、肾小球滤过率和颈动脉斑块稳定性等与脑小血管病(SVD)之间相关性,并进一步分析相关因素对脑SVD两种表现,脑小腔隙灶(LI)与白质疏松(WML)的影响是否一致,为更好的预防脑SVD提供依据.方法 纳入脑小血管病患者118例(LI 52例,WML66例)以及80例健康对照作为观察对象,检测所有研究对象的血脂,肾小球滤过率及颈动脉粥样斑块稳定性.采用t检验和卡方检验比较脑小血管病患者和对照组间各指标的差异,将具有统计学差异的因素筛选出来纳入多因素Logistic回归模型分析控制了其他因素作用后各指标的独立效应.结果 与健康对照组相比,脑SVD病人的HBAIC、LDL-C、TG水平都明显高于对照组,但HDL-C和GFR明显低于对照组(P<0.05).SVD患者与对照组的颈动脉粥样斑块特征具有统计学差异(χ2=61.76,P<0.001).多因素Logistic回归分析显示,在脑SVD、WML和LI亚组中,控制了其他因素的影响后,LDL-C高水平对象患脑SVD是低水平对象的7.71-15.95倍.研究对象颈动脉发现不稳定斑块与无斑块对象相比,患SVD的风险增加了17.44-23.14倍.在WML组中,TG≧1.70 mmol/L和颈动脉粥样稳定性斑块也与患WML患病相关(OR>1,P<0.05).结论 LDL-C高水平(2.6 mmol/L)和颈动脉粥样不稳定性斑块都是SVD患病的独立危险因素.除此之外,在WML组中,TG≧1.70 mmol/L和颈动脉粥样稳定性斑块也是患WML的危险因素.

Relationships between blood fat, giomerular filtration rate, carotid atherosclerotic claqueand and cerebral small vessel disease

Objective To explore the relationships between blood fat,glomerular filtration rate, carotid atherosclerotic claqueand and cerebral small vessel disease （SVD） as well as two subtypes of SVD- Lacunar Infarction （LI） and Matter Lesion （WML）. Methods A total of 118 SVD patients including 52 LI and 66 WML patients were enrolled. At the same period,80 healthy people were selected as controls. Blood fat,glomerular filtration rate,and carotid atherosclerotic claqueand were tested and then compared between SVD patients and controls using t and 2 tests. All the factors with significance different bteween two grougs were anlyzed in multivariable Logistic regression model to find the risk factors. Results The levels of HBAIC, LDL-C and TG of SVD patients were higher, while the levels of HDL-C and GFR were lower than those of controls significantly （P〈0.05）. The stability of carotid atherosclerotic claqueand was different between two groups （X^2= 61.76 ,P〈0. 001）. When other factors were controlled,the individuals with LDL-C more than 2.6 mmol/L,and those with unstable carotid atherosclerotic claqueand were more likely to be diagonosed as SVD （adjusted OR was from 7.71 to 15.95 for high LDL-C level,from 17.44 to 23.14 for unstable carotid atherosclerotic claqueand）. The TG≥1. 70 mmol/L and stable carotid atherosclerotic claqueand were found being related with WML （OR〉1,P〈0.05）. Conclusion LDL-C ≥ 2.6 mmol/L and unstable carotid atherosclerotic claqueand are risk factors for SVD. In addition to this,TG≥l. 70 mmol/L and stable carotid atherosclerotic claqueand are the other risk factors for WML.