高龄缺血性脑白质损害患者的临床分析

目的探讨高龄缺血性脑白质损害患者的危险因素和临床特点。方法将248例>75岁的缺血性脑白质损害患者分为3组:轻度脑白质损害组(轻度损害组,88例)、中度脑白质损害组(中度损害组,104例)和重度脑白质损害组(重度损害组,56例)。采用logistic回归分析其危险因素,并对临床特征进行分析比较。结果轻度、中度和重度脑白质损害患者所占比例分别为35.5%、41.9%和22.6%;年龄和血压与脑白质损害程度相关;非特异性神经系统症状(34.7%)、运动功能减退(24.6%)和认知功能减退(21.4%)为主要就诊原因,差异显著(P<0.05)。结论年龄和高血压是脑白质损害的危险因素;运动和认知功能障碍是脑白质损害的重要临床特征。     

老年人脑白质损害与认知功能的关系

目的探讨老年人脑白质损害(WML)与认知功能的关系。方法选择457例男性老年人行头颅CT及数字广度、言语流畅、积木测验、词语延迟回忆、连线测验A、符号数字检查,按头颅CT表现将研究对象分为无WML(132例)、轻度WML(147例)、中度WML(105例)及重度WML(73例)4组。多因素协方差分析比较不同组别各项神经心理测验结果;用logistic回归分析不同WML状态下认知功能损害的相对危险性。结果重度WML组各项认知检测分数较无WML组有显著性差异(P<0.01),重度WML是各项认知功能损害的危险因素(P<0.01)。中度WML组在部分认知项目上与无WML组有显著性差异(P<0.01),轻度WML组与无WML组的认知功能无显著性差异(P>0.05)。结论轻度WML对认知的影响不明显,WML严重到一定程度时将使老年人认知功能产生广泛损害。     

老年人轻度锥体外系症状的临床意义

目的探讨老年轻度锥体外系征(EPS)的临床意义。方法随机选取无明显神经系统疾病的老年患者150例,记录轻度EPS、脑白质损害(WML)、全身疾病及日常生活能力(ADL)评分。Logistic回归分析伴发轻度EPS对ADL的影响。结果61例老年人伴有轻度EPS,合并轻度EPS者的年龄(75.3±3.9)岁、日常生活能力受损(40/61)和并发全身疾病(39/61)的比例较无轻度EPS者〔分别为(73.9±2.9)岁、30/89、37/89)明显增高(P<0.01〕。两组WML发生的比例无明显差异(P>0.05)。控制年龄、全身疾病及WML的影响后,轻度EPS仍是日常生活能力受损的独立危险因素。结论老年人伴发的轻度EPS具有重要的临床意义,与日常生活能力下降密切相关。     

高龄糖尿病患者缺血性脑白质病变严重程度及其危险因素分析

目的探讨高龄(≥80岁)糖尿病患者缺血性脑白质病变(WML)严重程度及其相关危险因素分析。方法选择安徽医科大学第三附属医院神经内科及干部病房住院的行头颅MRI检查的缺血性WML患者202例,分为糖尿病组105例和非糖尿病组97例,糖尿病组根据年龄相关性脑白质改变(ARWMC)评分为WML轻度患者(1~4分)35例、中度患者(5~8分)46例和重度患者(≥9分)24例。收集患者临床基线资料,采用Kendall等级相关分析,采用多因素logistic回归分析WML相关危险因素。结果糖尿病组空腹血糖、餐后2 h血糖、ARWMC评分明显高于非糖尿病组,HDL-C水平明显低于非糖尿病组(P<0.05)。糖尿病组不同程度WML患者年龄、空腹血糖、餐后2 h血糖及糖化血红蛋白(HbA1c)水平比较,差异有统计学意义(P<0.05,P<0.01)。轻度、重度及重度患者随症状加重其空腹血糖、餐后2 h血糖及HbA1c水平明显升高(P<0.05)。与轻度患者比较,中度和重度患者年龄更高,重度患者糖尿病病程更长(P<0.05)。多因素logistic回归分析显示,年龄、HbA1c水平升高是缺血性WML严重程度的独立危险因素(95%CI=0.128~0.454,P=0.000;95%CI=1.941~5.623,P=0.000)。所有缺血性WML患者,年龄与WML严重程度呈正相关(P=0.000)。糖尿病患者年龄、HbA1c水平、糖尿病病程与缺血性WML严重程度呈正相关(P<0.05,P<0.01)。在校正高血压、血脂、尿酸水平等危险因素后,糖尿病病程与缺血性WML严重程度的无关(P=0.210)。结论年龄是缺血性WML的独立危险因素,在糖尿病患者中,HbA1c水平可能与缺血性WML严重程度相关。     

老年心血管疾病患者合并骨骼肌质量下降的临床特点

目的探讨老年心血管疾病合并骨骼肌质量下降患者的临床特点。方法选择心血管疾病患者310例,根据肌少症诊断标准,将患者分为骨骼肌质量下降组209例和无骨骼肌质量下降组101例。其中年龄≥80岁168例,年龄<80岁142例。测定骨骼肌质量,记录患者的基本情况、既往病史、生化指标,建立logistic回归模型筛选独立危险因素。结果年龄≥80岁患者骨骼肌质量下降比例明显高于年龄<80岁患者(82.14%vs 50.00%,P<0.05)。骨骼肌质量下降组年龄[(81.57±8.61)岁vs(73.51±9.50)岁,P<0.01]、男性(74.16%vs 53.47%,P<0.01)、吸烟及慢性阻塞性肺疾病比例、血肌酐、HDL和高敏C反应蛋白水平较无骨骼肌质量下降组明显升高,体质量指数、日常生活活动能力评分、血清白蛋白水平、估算的肾小球滤过率和TG水平较无骨骼肌质量下降组明显降低(P<0.05,P<0.01)。logistic回归分析显示,年龄≥80岁、低白蛋白水平、低体质量指数、男性是骨骼肌质量下降的独立危险因素(P<0.05,P<0.01)。结论老年心血管疾病患者合并骨骼肌质量下降的患病率高,生活能力及营养水平下降。高龄、低白蛋白水平、低体质量指数,男性可能是发生骨骼肌质量下降的危险因素。     

持续性非卧床腹膜透析患者发生首次相关性腹膜炎的危险因素分析

目的探讨持续性非卧床腹膜透析(CAPD)患者发生首次腹膜透析相关性腹膜炎(PDAP)的危险因素。方法选择新诊断慢性肾功能衰竭、采取腹膜置管透析治疗的CAPD患者94例。随访6个月至3年,依据腹膜透析期间是否发生腹膜炎分为首次发生PDAP组和非PDAP组。比较两组患者的基本情况、生化指标和透析相关指标等,采用多因素非条件logistic回归法分析导致首次PDAP发生的危险因素。结果94例CAPD患者中共有36例发生PDAP,发生率为38.29%(36/94)。与非PDAP组相比,首次发生PDAP组患者年龄较大(t=3.681,P<0.01)、血小板计数较高(t=7.491,P<0.01)、血红蛋白较低(t=-4.114,P<0.01)、白蛋白较低(t=-9.125,P<0.01)、尿酸较高(t=3.122,P=0.003)、血磷较高(t=5.411,P<0.01)、甘油三酯较低(t=-4.006,P<0.01)、合并糖尿病比例较多(χ2=15.332,P<0.01)。多因素非条件logistic分析显示,血小板计数升高、高磷和合并糖尿病是导致首次PDAP发生的危险因素,而白蛋白升高和血红蛋白升高是有效减少首次PDAP发生的保护因素(P均<0.05)。结论血小板计数升高、高磷和合并糖尿病是导致CAPD患者发生PDAP的危险因素,而白蛋白升高和血红蛋白升高是减少PDAP发生的保护因素。     

老年急性缺血性脑卒中患者脑微出血严重程度的影响因素研究

目的 探讨老年急性缺血性脑卒中(AIS)患者脑微出血(CMB)严重程度的影响因素。方法 回顾性选择2020年1月～2021年6月威海市立医院神经内科收治的老年AIS合并CMB患者113例,根据CMB的严重程度分为CMB 1级组19例,CMB 2级组40例,CMB 3级组54例。收集各组临床资料,采用有序多分类logistic回归分析影响老年AIS患者CMB严重程度的危险因素。结果 3组脑白质高信号(WMH)分级比较,差异有统计学意义(P<0.01);CMB 1级组、CMB 2级组、CMB 3级组饮酒比例逐渐升高,糖尿病比例、TG及空腹血糖水平逐渐降低(P<0.05,P<0.01)。有序多分类logistic回归分析显示,糖尿病、饮酒、WMH分级1级和2级是老年AIS患者CMB严重程度的危险因素(95%CI:0.115～0.841,P=0.021;95%CI:1.432～11.612,P=0.008;95%CI:0.016～0.179,P=0.000;95%CI:0.029～0.278,P=0.000)。结论 糖尿病、饮酒、WMH分级是老年AIS患者CMB严重程度的危险...     

脑小血管病患者跌倒风险的临床研究

目的 研究脑小血管病患者影像学标志物与跌倒风险之间的关系。方法 纳入2020年9月至2021年12月在解放军总医院第七医学中心神经内科住院的脑小血管病患者142例,分为有跌倒风险组58例和无跌倒风险组84例。所有患者行影像学标志物分析,包括脑白质高信号、腔隙性脑梗死、脑微出血,采用唐顿跌倒风险指数(DFRI)进行跌倒风险评估,DFRI≥3分为有跌倒风险。采用logistic回归分析法研究DFRI与神经影像标志物的相关性。结果 有跌倒风险组与无跌倒风险组年龄、性别、受教育年限、心绞痛、心肌梗死、糖尿病以及偏头痛比较,差异无统计学意义(P>0.05)。有跌倒风险组高血压、高脂血症、中重度脑白质高信号比例明显高于无跌倒风险组(82.8%vs 48.8%,84.5%vs 56.0%,75.9%vs 41.7%,P<0.01)。2组脑小血管病总负荷评分比较,差异有统计学意义(P<0.01)。2组脑微出血和腔隙性脑梗死比例比较,差异无统计学意义(P>0.05)。校正高血压、高脂血症等有意义的混杂因素后,中重度脑白质高信号是DFRI升高的危险因素(OR=4.136,95%CI...     

他汀类药物预治疗对老年急性脑梗死患者预后影响的研究

目的探讨他汀类药物预治疗对老年急性脑梗死患者预后的影响。方法选择首发或无明显遗留症状的再发急性脑梗死患者370例,依据发病前是否规律服用他汀类药物将患者分为他汀预治疗组(他汀组)132例和非他汀组238例,比较2组患者血管病危险因素、脑梗死严重程度、发病后2周的预后良好比例、死亡比例及并发症情况,采用logistic回归分析可能与脑梗死早期预后相关的危险因素。结果他汀组患者糖尿病、冠心病、高脂血症、外周血管疾病、颅内外血管狭窄、预后良好比例明显高于非他汀组(P<0.01)。2组患者高血压、美国国立卫生研究院卒中量表评分、并发症及死亡比例差异无统计学意义(P>0.05)。logistic回归分析显示,脑梗死早期预后与服用他汀类药物相关(P<0.01)。结论他汀类药物预治疗能够改善老年急性脑梗死的早期预后。     

老年肾功能损害与冠心病关系的研究

目的研究老年人肾功能损害与冠心病患病的关系。方法选择年龄>65岁老年患者1264例,根据慢性肾脏病分期及估算肾小球滤过率(eGFR)分为5组:≥90 ml/(min·173 m~2)为对照组508例、60～89 ml/(min·173m~2)组(A组)403例、30～59 ml/(min·173 m~2)组(B组)221例、1 5～29 ml/(min·1 73 m~2)组(C组)104例和<15ml/(min·1 73 m~2)组(D组)28例。采用logistic回归分析肾功能与冠心病之间的关系。结果与对照组比较,C组和D组患者冠心病患病率明显升高,差异有统计学意义(P<0.05,P<0.01);且男性较女性冠心病患病率明显升高,差异有统计学意义(P<0.05,P<0.01)。logistic回归分析显示,调整影响冠心病危险因素后,冠心病风险仍随eGFR的降低而增加(P=0.00)。结论年龄>65岁老年患者肾功能损害是其患冠心病的一个独立危险因素。     

Silent cerebral white matter lesions in middle-aged essential hypertensive patients

OBJECTIVE : Age, hypertension, diabetes mellitus and a history of cardiovascular disease are the most important factors related to the presence of cerebral white matter lesions (WML), which are a common finding in elderly people. This study investigates which factors related to hypertension per se are associated with the presence of WML in asymptomatic, middle-aged, never-treated essential hypertensive patients. METHODS : A total of 66 untreated essential hypertensive patients of both genders, aged 50-60 years, with neither diabetes mellitus nor evidence of cardiovascular disease, were studied. Hypertensive patients were classified into two groups according to the presence or absence of WML in brain magnetic resonance imaging (MRI). RESULTS : A total of 39 (59.1%) hypertensives showed no WML in brain MRI, and 27 (40.9%) exhibited the presence of WML. Compared with hypertensives without WML, patients with WML showed significantly higher values of both office and 24 h ambulatory blood pressure monitoring (ABPM) systolic, diastolic, mean and pulse pressure. No differences were observed in either the nocturnal fall of blood pressure, or in blood pressure variability, assessed by 24 h standard deviation, among hypertensives with WML. In contrast, the nocturnal decline of heart rate was significantly blunted in patients with WML, compared with those without WML. CONCLUSIONS : Cerebral white matter lesions are a common finding in asymptomatic middle-aged essential hypertensives. The severity of blood pressure elevation seems to be the most important factor related to the presence of WML. Neither the circadian rhythm nor the long-term variability of blood pressure were related to WML.     

老年高血压病患者左心室肥厚与脑白质疏松症的关系

目的　探讨老年高血压病患者左心室肥厚和脑白质疏松症 (LA)的关系。方法　 13 8例老年高血压病患者 ,按有或无LA分为两组 ,并对其年龄、是否合并左心室肥厚、糖尿病、高胆固醇血症、吸烟史以及收缩压和舒张压水平、高血压病持续时间进行分析。结果　在单因素Logistic回归分析中 ,左心室肥厚、收缩压水平、高血压病持续时间及年龄均为LA的影响因素 ;在多因素条件Logistic回归分析中 ,左心室肥厚仍为LA的危险因素之一 (OR =2 .771,95 %CI值 1.2 60～6.0 94;P <0 .0 1)。结论　左心室肥厚为老年高血压病患者LA独立的危险因素。     

存在血管危险因素的老年人脑白质损害与认知功能障碍的关系

目的探讨存在血管危险因素老年人不同程度脑白质损害(WML)与认知障碍的关系。方法选择WML患者195例,根据WML程度分为轻度组(54例),中度组(63例),重度组(78例),另选健康体检者70例作为对照组。所有受试者行神经心理学测试,包括简易智能状态检查量表、蒙特利尔认知评估量表、听觉词语记忆、逻辑记忆、复杂图形记忆、Stroop色词测验、连线测验B、相似性、言语流畅、数字广度、搜钟和画钟测验。结果与对照组比较,随着WML程度加重,轻、中、重度组血管危险因素明显升高(P<0.05);轻度组记忆、注意、语言及部分执行功能评分明显较对照组差(P<0.05,P<0.01),重度组各项测验评分明显较其他各组差(P<0.01)。各项测验评分与WML严重程度评分呈负相关(P<0.01)。结论血管危险因素可加重WML;轻度WML即对认知功能有影响,重度WML表现广泛认知损害;认知障碍程度与WML严重程度呈正相关。     

Cerebral white matter lesions in essential hypertension

The pathogenesis and clinical significance of cerebral white matter lesions (WML) remain controversial. Most studies have shown that age, hypertension, diabetes mellitus, and a history of stroke or heart disease are the most important factors related to the presence of cerebral WML. Moreover, some studies suggest that the presence of WML are closely related to cerebrovascular disease and cognitive impairment in elderly patients with vascular risk factors, particularly hypertension. In this review, different points of view about cerebral WML are discussed, with special focus on the presence of WML in essential hypertension. Some authors suggest that the presence of WML in hypertensive patients could be considered an early marker of brain damage.     

White matter lesions as a feature of cognitive impairment, low vitality and other symptoms of geriatric syndrome in the elderly

Aim:   White matter lesions (WML) are common findings on magnetic resonance imaging (MRI) in elderly persons. In this study, we analyzed the relation of WML with global cognitive function, depression, vitality/volition, and 19 symptoms of geriatric syndrome in Japanese elderly patients who attended three university geriatric outpatient clinics.
Methods:   Two hundred and eighty-six subjects (103 men and 183 women; mean ± standard deviation age, 74.5 ± 7.8 years) were included in this study. MRI scans were performed for the diagnosis of WML, and the severity of periventricular and deep white matter hyperintensities (PVH and DWMH) was rated semiquantitatively. Concurrently, all subjects underwent tests of cognitive function, depressive state and vitality, and were examined for 19 symptoms of geriatric syndrome.
Results:   The study subjects showed cognitive decline, depression and low vitality, all to a mild extent. Univariate linear regression analysis showed a negative correlation between the severity of WML and cognitive function or vitality. Multiple logistic analysis revealed that the severity of WML was a significant determinant of cognitive impairment and low vitality, after adjustment for confounding factors such as age, sex and concomitant diseases. PVH and/or DWMH score was significantly greater in subjects who exhibited 13 out of 19 symptoms of geriatric syndrome. Logistic regression analysis indicated that WML were associated with psychological disorders, gait disturbance, urinary problems and parkinsonism.
Conclusion:   WML were associated with various symptoms of functional decline in older persons. Evaluating WML in relation to functional decline would be important for preventing disability in elderly people.     

老年人慢性肾功能不全与脑小血管病变

目的 探讨老年人慢性肾功能不全(CKD)与脑小血管病变(SVD)的关系.方法 老年CKD组152例和老年对照受试者158例,均为男性,记录人口学资料和血管危险因素,根据头颅MRI结果 半定量评估脑白质病变(WML)和计算腔隙性梗死数(LI). 结果 (1)与对照组比较,老年CKD组高血压(30.9%对19.0%)、糖尿病(23.7%对14.6%)患病率明显升高(X2值分别为5.91和4.19,P<0.05);(2)与对照组比较,老年CKD组WML2级(34.9%对24.1%)和3级(25.7%对16.5%)比率明显升高(X2=4.37和3.96,P<0.05);LI患病率明显升高,为45.4%对25.3%(X2=13.70,P<0.05);除外高血压和糖尿病对照组仍得到类似的结果 ;(3)多元Logistic回归分析显示,年龄、高血压和肾小球滤过率(GFR)与老年CKD患者SVD的发生密切关联(OR值分别为3.47、3.63和1.91). 结论 高血压和糖尿病町能是老年CKD的危险因素;老年CKD与脑SVD密切关联;年龄、高血压和GFR降低可能是老年CKD患者脑SVD的独立危险因素.     

老年冠心病患者合并非酒精性脂肪性肝病的危险因素分析

目的探讨老年冠心病患者合并非酒精性脂肪性肝病(NAFLD)的患病率和危险因素。方法入选冠状动脉造影诊断为冠心病的老年患者359例,NAFLD组172例,非NAFLD组187例,住院期间经腹部超声检查和采集病史,观察2组患病率、肝脏酶学异常比例及其与冠状动脉病变程度的关系。结果 NAFLD组糖尿病、丙氨酸转氨酶、天冬氨酸转氨酶水平明显高于非NAFLD组,差异有统计学意义(P<0.05,P<0.01)。NAFLD与冠状动脉病变严重程度呈正相关(χ2=16.182,P<0.01)。NAFLD组患者斑块检出率、斑块数目明显高于非NAFLD组,差异有统计学意义[89.7%vs 78.3%,(2.27±1.20)个vs(1.81±1.32)个,P<0.05]。多因素logistic回归分析显示,糖尿病和冠状动脉多支病变(或左主干病变)与NAFLD的发生相关。结论老年冠心病患者NAFLD的患病率随着冠状动脉病变程度加重而增加。     

Diabetes Mellitus in the Aging: Epidemiologic and Therapeutic Considerations

Diabetes mellitus is prevalent in older persons and a major risk factor for the development of cardiovascular disease. Impaired glucose tolerance without overt diabetes has also been shown to be associated with an increased risk of cardiovascular disease. Elderly patients with non-insulin-dependent diabetes mellitus are at increased risk for both symptomatic and asymptomatic myocardial infarction, and appear to have worse outcomes than nondiabetic persons with these same conditions. Older diabetic persons also have a greater risk than nondiabetics of developing systemic hypertension and stroke. Treatment of diabetes in the elderly can be divided into treatment of the hyperglycemia itself and treatment of other cardiovascular risk factors. It is unknown whether treatment of hyperglycemia in older patients will decrease the risk of cardiovascular and cerebrovascular disease, but it is proposed that treating diabetes along with other commonly associated risk factors for cardiovascular disease may provide the best outlook for such patients.     

老年冠心病患者介入治疗术后对比剂肾损伤发生率及危险因素分析

目的探讨老年冠心病患者PCI术后对比剂肾损伤(contrast-induced nephropathy,CIN)发生情况及危险因素。方法选取行PCI的老年冠心病患者945例,按照CIN诊断标准分为CIN组150例和非CIN组795例,比较2组相关因素的差异,应用多元logistic回归分析探讨CIN危险因素。结果 945例老年患者中,150例发生CIN,CIN发生率为15.9%。2组患者年龄、心肌梗死、糖尿病、低血压、红细胞计数、血红蛋白、贫血、LVEF、术前肾小球滤过率(GFR)、对比剂剂量等比较,差异有统计学意义(P<0.01)。多元logistic回归分析,心肌梗死、糖尿病、贫血、低血压、LVEF≤45%、GFR≤60 ml/(min·1.73 m~2)、急诊PCI、对比剂剂量>200 ml是老年冠心病患者CIN的危险因素(P<0.05,P<0.01)。结论 CIN是老年冠心病患者PCI术后一种不容忽视的并发症,患者行PCI时,应引起临床医师的格外重视。     

血清尿酸水平与老年冠心病患者易感风险因素的相关性研究

目的分析血清尿酸水平与老年冠心病易感风险因素的相关性。方法回顾性采集2017年1月至2019年1月我医院老年冠心病患者200例(冠心病组)和同期医院门诊接诊的非冠心病老年患者150例(对照组)的临床资料。患者入院后即刻采集外周静脉血,测定血清尿酸水平;并记录各基线资料情况,将冠心病可能的易感风险因素纳入,经单因素与多因素分析找出风险因素,分析血清尿酸水平与老年冠心病患者各易感风险因素的相关性。结果初步单因素分析发现,吸烟、合并糖尿病、低高密度脂蛋白胆固醇(HDL-C)血症、冠心病家族史、肾小球滤过率等均可能是老年冠心病患者易感风险因素(χ^2=6.739、15.655、6.331、9.615、23.279,P均<0.05);多因素分析证实,吸烟、合并糖尿病、低HDL-C血症、冠心病家族史、肾小球滤过率均是老年冠心病易感风险因素(OR=1.777、2.381、1.883、1.967、3.205,均P<0.05);吸烟、合并糖尿病、低HDL-C血症、有冠心病家族史、肾小球滤过率<100 ml/min的老年冠心病患者,其血清尿酸水平均高于其他患者(t=8.017、5.907、8.509、7.164、13.839,均P<0.001);经Spearman相关性分析检验证实,血清尿酸水平与老年冠心病患者吸烟、合并糖尿病、冠心病家族史等易感风险因素均呈正相关(r=0.409、0.422、0.422,均P<0.001),与低HDL-C血症、肾小球滤过率呈负相关(r=-0.428、-0.481,均P<0.001)。结论血清高尿酸水平与吸烟、糖尿病等诸多冠心病易感风险因素有紧密联系,可能是冠心病发病的独立危险因素。