脑白质疏松症患者的相关危险因素分析

目的探讨血浆同型半胱氨酸(Hcy)、年龄、高血压及糖尿病与脑白质疏松严重程度的相关性。方法对比分析123例LA患者和60例正常对照组之间血浆同型半胱氨酸、年龄、高血压、糖尿病及糖化血红蛋白(HbA1c)。结果 LA组较对照组Hcy、HbA1c、高血压及糖尿病发生率显著增高(P0.05)。回归分析显示,Hcy、年龄、高血压病程及HbA1c与LA严重程度呈正相关。结论 Hcy升高、年龄、高血压病程及HbA1c与LA严重程度密切相关。     

脑白质疏松症的临床危险因素分析

目的探讨脑白质疏松症的临床危险因素。方法回顾性分析2015-01-01—2016-06-01连续收治的116例脑白质疏松症患者的临床资料,利用脑白质疏松症Fazekasz量表评分将LA患者分为中度组(n=70)和重度组(n=46),并对其临床资料进行统计学处理。结果脑白质疏松症合并高血压史85例(73.2%),糖尿病15例(12.9%),脂代谢异常76例(65.5%),大动脉粥样硬化63例(54.3%),平均同型半胱氨酸水平为21.98mg/L。与中度组相比,重度组年龄较大,胆固醇、低密度脂蛋白、载脂蛋白A及载脂蛋白B的水平更低(P0.05);而同型半胱氨酸水平更高(P0.05)。结论年龄、高血压、脂代谢异常、同型半胱氨酸水平等因素均与LA的发生有关;其中高龄和高同型半胱氨酸与LA的发生有关,而血胆固醇、低密度脂蛋白及载脂蛋白A、B为LA的保护因素,其降低与更高的Fazekasz量表评分有关。     

阿尔茨海默病与脑白质疏松血浆同型半胱氨酸水平的相关性研究

目的探讨阿尔茨海默病(AD)与缺血性脑白质疏松症(LA)、血浆同型半胱氨酸(Hcy)及叶酸、维生素B_(12)水平的相关性。方法采用简易智能状态量表(mini-mental state examation,MMSE)检查患者的认知功能,根据MMSE评分和AD的诊断标准收集病例,共收集AD患者60例,正常对照组64例。通过头颅MRI检查筛选LA病例,AD伴LA者36例,无LA的AD患者24例;对照组无LA 40例,伴LA的正常对照组24例;用化学免疫发光法测定2组血浆同型半胱氨酸、叶酸、维生素B_(12)水平,同时检测所有受试者的血压、血糖、血脂、体重指数、教育情况等。结果与对照组比较,AD组血浆同型半胱氨酸升高(P0.05),叶酸和维生素B_(12)水平下降(P0.05);通过应用R×C资料的卡方检验得出AD组与对照组脑白质疏松发生率差异有统计学意义(P=0.010);对AD组脑白质疏松和认知障碍程度进行Spearman相关性分析得出,AD组认知障碍程度与脑白质疏松程度呈正相关(r_s=0.430,P=0.010)。结论高Hcy可能参与AD的发病,而LA发生加重了认知功能损伤,适当补充叶酸和维生素B_(12)可有助于改善痴呆患者的临床症状。     

血浆同型半胱氨酸与不同类型脑小血管病相关性分析

目的：分析血同型半胱氨酸（Hcy）与不同类型脑小血管病的相关性。方法纳入脑小血管病患者123例（病例组）,其中单纯脑白质疏松症（LA）39例,腔隙性梗死（LI）35例,脑微出血（CMB）16例,脑白质疏松并腔隙性梗死和（或）脑微出血33例,40例健康者为对照组。对2组患者均进行Hcy检测。结果LA、LI、CMB及脑白质疏松并腔隙性梗死和（或）脑微出血组血浆同型半胱氨酸均高于对照组（P＜0.05）,脑白质疏松并腔隙性梗死和（或）脑微出血组血浆同型半胱氨酸明显高于其他3组脑小血管病组（P＜0.05）,LA、LI及CMB血浆同型半胱氨酸无明显差异。结论Hcy与脑小血管病（SVB）的病情严重程度具有密切关系。     

急性脑卒中患者糖代谢异常研究

目的 探讨急性脑卒中患者糖代谢异常的流行状况.方法 将202例新发脑卒中连续病例分为已知糖尿病组和非已知糖尿病组,对所有空腹血糖(fasting plasma glucose,FPG)＜7.0mmol/L的非已知糖尿病患者均行糖耐量试验(oral glucose tolerance test,OGTT) .结果 急性脑卒中患者糖代谢异常的比例高达 66.4%,其中单纯性负荷后高血糖(isolated postprandial hyperglycemia,IPH)为 14.4%,单纯性糖耐量受损(isolated impaired glucose tolerance, I-IGT)为 23.3%.若不进行OGTT试验,仅依靠检测空腹血糖,将有100%I-IGT患者和80.6%糖尿病患者被漏诊.结论 急性脑卒中患者中存在普遍的糖代谢异常,糖耐量试验是及时发现I-IGT和IPH的有效方法.     

老年人脑白质疏松的相关危险因素

目的探讨老年人脑白质疏松(LA)的相关危险因素。方法采集轻度组、中度组及重度组患者的临床资料,并检测其血浆同型半胱氨酸(Hcy)水平。结果轻度组、中度组、重度组的年龄、男性及高血压比例差异有统计学意义(均P0.05),而糖尿病、冠心病、高脂血症及吸烟比率差异均无统计学意义。3组间血浆Hcy水平及高Hcy血症(HHcy)患者比率差异有统计学意义(均P0.01)。多因素分析显示,年龄(OR=1.078,95%CI:1.034~1.123,P=0.000)、男性(OR=2.601,95%CI:1.441~4.692,P=0.002)、高血压(OR=2.672,95%CI:1.493~4.783,P=0.001)、Hcy(OR=1.035,95%CI:1.009~1.059,P=0.007)及HHcy(OR=1.954,95%CI:1.055~3.618,P=0.033)是LA独立危险因素。结论 HHcy、年龄、男性、高血压是老年人LA的独立危险因素。     

高血压并发不同程度糖代谢异常血浆PAI-1水平变化

目的 探讨高血压患者并发不同程度糖代谢异常血浆纤溶酶原激活物抑制剂-1(PAI-1)相关性及其影响.方法 160例高血压患者,根据空腹血糖(FPG)和OGTT检查2h血糖(2HPG)试验结果分为3组:糖耐量正常(NGT)组、糖耐量异常(IGT)组和糖尿病(DM)组.用酶联免疫双抗体吸附法(ELISA法)测定3组患者血浆PAI-1抗原.结果 单因素方差分析(ANVOA)显示,NGT＼IGT和DM 3组PAI-1水平差异有统计学意义;以PAI-1与年龄、收缩压(SBP)、舒张压(DBP)、FPG、2HPG作直线回归分析,能进入该方程的变量为年龄、SBP、DBP、2HPG.结论 高血压患者伴发糖代谢异常及其严重程度与PAI-1升高正相关;年龄、SBP、DBP、2HPG为PAI-1独立影响因素.     

H型高血压和脂蛋白相关磷脂酶A2对脑白质疏松症严重程度及预后的影响

目的 探讨H型高血压和脂蛋白相关磷脂酶A2(Lp-PLA2)对脑白质疏松症(LA)严重程度及预后的影响.方法 前瞻性入选沧州市中心医院2016年3月至2018年3月行头颅CT检查诊断有LA的住院患者,入院后24h内空腹化验血清Lp-PLA2;根据有无高血压和高同型半胱氨酸血症(Hhcy),把LA患者分为:A.同时伴高血...     

脑白质疏松症患者的认知水平与血浆同型半胱氨酸水平和颈部血流动力学的相关性

目的 探讨脑白质疏松症(LA)患者认知功能、血浆同型半胱氨酸(Hcy)水平与颈动脉血流动力学指标的关系.方法 测试LA患者认知损害水平,根据结果分为三组,分别为痴呆组、轻度认知功能障碍组和无认知功能障碍组.根据三组患者的血浆Hcy水平及颈部血管超声血流动力学指标进行相关性分析.结果 痴呆组患者的血浆Hcy水平较轻度认知功能障碍组与无认知功能障碍组增高(P<0.05),双侧颈内动脉阻力指数(RI)、搏动指数(PI)亦较轻度认知功能障碍组与无认知功能障碍组增高(P<0.05).结论LA患者不同水平认知功能与血浆Hcy水平和颈部血管超声变化存在相关性,血浆Hcy水平越高,RI和PI越高,则认知损害越重.     

不同性别高血压患者血浆同型半胱氨酸水平的差别

目的探讨不同性别高血压患者血浆同型半胱氨酸(Hcy)水平的差别。方法选择2014-01—2014-06某院接诊的高血压患者中随机抽取男女各100例患者进行研究。男性为观察组,女性为对照组,各100例。比较2组一般临床资料、同型半胱氨酸分布区间以及血浆Hcy的多元线性回归分析。结果 2组年龄、病程、收缩压、高密度脂蛋白、高血压分级、血糖、服药规律比率相比差异无统计学意义(P0.05)。观察组的BMI、舒张压均高于对照组(P0.05);观察组与对照组的同型半胱氨酸分别为(17.9±3.2)μmol/L与(12.2±2.6)μmol/L,观察组同型半胱氨酸高于对照组(P0.05)。观察组与对照组中同型半胱氨酸15.0μmol/L的比率分别为77.00%与2.00%,显示观察组的同型半胱氨酸浓度显著高于对照组(u=9.885 1,P0.000 1)。调整BMI、舒张压以后,观察组的同型半胱氨酸仍显著高于对照组(P0.05)。结论高血压患者血浆同型半胱氨酸(Hcy)水平与性别存在显著相关性,高血压男性患者的血浆同型半胱氨酸(Hcy)水平高于女性患者。     

脑白质疏松症患者认知功能与海马代谢关系的研究

目的探讨脑白质疏松症患者认知损害与海马代谢间的关系。方法对108例性别、受教育程度和脑血管病危险因素相匹配且有记忆力减退主诉的患者进行神经心理学评价,通过氢质子磁共振波谱测量左侧海马区N-乙酰天冬氨酸／肌酸、肌醇／肌酸、胆碱复合物／肌酸,以及谷氨酸和谷氨酰胺复合物a峰／肌酸比值,以观察与记忆相关脑区的代谢物变化。结果脑白质疏松症组患者简易智能状态检查量表（24．00）和蒙特利尔认知评价量表（16．50）中位数评分低于对照组（27．00和21．00）,组间差异有统计学意义（均P=0．000）;其中以视觉执行能力（1．00：3．00）、注意力（4．00：5．00）、语言（1．00：2．00）、延迟回忆（0．00：2．00）等项评分降低最为显著（P〈0．05或P〈0．01）。韦氏记忆量表中文修订版进一步测验显示,脑白质疏松症组患者瞬时记忆（5．06±2．86）和短时记忆（32．76±13．31）评分均显著低于对照组[（7．68±4．41）和（46．95±14．81）],且差异具有统计学意义（P〈0．05或P〈0．01）;左侧海马区N-乙酰天冬氨酸、肌醇、胆碱复合物与肌酸比值测定,两组差异无统计学意义（P〉0．05）。结论脑白质疏松症引起的认知损害主要表现为视觉执行能力、注意力、语言及记忆（瞬时记忆和短时记忆）显著降低,未发现这一改变与左侧海马代谢变化有关。     

脑白质疏松对脑血管事件和认知功能的影响

目的 评估脑白质疏松（leukoaraiosis,LA）的危险因素,以及对老年患者后期脑血管事件和认知功能障碍发病率的影响。 方法 连续入组北京安贞医院神经内科253例门诊患者,分为LA组和对照组,按照LA的严重程度,LA组分为轻度组、中度组、重度组。将简明精神状态量表（Mini-Mental State Examination,MMSE）和蒙特利尔认知评估量表（Montreal Cognitive Assessment,MoCA）（北京版）作为认知评估工具。分析各组患者一般临床资料和认知功能,随访观察并比较各组患者脑梗死、脑出血以及认知功能障碍的发病率。 结果 LA组与对照组相比,患有高血压、糖尿病的比例显著升高,差异有显著性（P值分别为0.003和0.004）。中、重度LA组与对照组相比,认知障碍的患病率显著升高（P值分别为0.035和0.019）。随访1年,轻、中、重度LA组脑梗死的发病率均高于对照组,差异有显著性（P值分别为0.019、0.024和0.049）。四组间脑出血的发病率无显著差异。轻、中、重度LA组的新发认知障碍的发病率高于对照组,差异有显著性（P值分别为0.048、0.036和0.004）。 结论 老年LA患者认知障碍的患病率高于无白质疏松人群,且1年内新发认知障碍和缺血性卒中的发病率也高于无白质疏松人群。     

Leukoaraiosis in stroke patients

Pathogenesis of leukoaraiosis (LA) is not clearly understood and its significance in patients with stroke remains undetermined. In the Neurology Department of Ankara Hospital, computed tomography (CT) examination of brain was performed for various reasons in 288 patients. LA was detected in 178 patients by the use of brain CT. Patients with LA had a higher incidence of hypertension history (70.8%) when compared with the non-LA group (57.3%; p <.05). There was no statistically significant difference in terms of sex, mean age, smoking, diabetes mellitus, history of cerebrovascular disease, cardiac failure, ischemic cardiac disease between patients with and without LA. We showed that LA is related to hypertension but not related to age, diabetes mellitus, or cardiac disease in our patient population.     

Correlation of retinopathy with leukoaraiosis in patients with anterior circulation infarcts

Although retinal and cerebral microvessels share similar embryological, anatomical and physiological characteristics, the correlation between retinopathy and leukoaraiosis (LA), a type of brain microvascular disease, is unclear. In the present study, the sample included 213 patients admitted to the department of neurology from January 2012 through October 2012. MRI and retinal photography were performed within 48 hours of hospitalization, and patient demographics, comorbidities, preadmission medications and laboratory data were collected. MRI images were used to divide the patients into LA and non-LA groups. Using multivariate binary logistic regression, the effects of retinopathy on LA were investigated. Of the 213 patients enrolled, 168 were included in this study (LA, n = 108; non-LA, n = 60). Hypertension, coronary heart disease and carotid artery plaque were more common in the LA group, and these patients showed higher blood levels of C-reactive protein, homocysteine and triglycerides. The incidence of retinopathy was significantly increased in the LA group compared with the non-LA group, and there was a significant correlation between the severity of LA and incidence of retinopathy. Retinopathy is an independent risk factor for LA and can significantly increase the risk of LA when combined with age, coronary heart disease, C-reactive protein, carotid artery plaque or systolic pressure. Taken together, retinopathy is associated with LA in patients with anterior circulation infarcts. Retinopathy is an independent risk factor for LA and an increase the risk of LA, and thus facilitating the evaluation of LA.     

伴智能障碍的脑白质疏松症患者相关危险因素分析

目的分析伴智能障碍的脑白质疏松症(LA)患者的相关危险因素。方法 207例LA患者分为伴有智能障碍组和无智能障碍组,对患者的性别、年龄、高血压病史、糖尿病史、冠心病史及既往脑梗死病史等进行相关因素分析和Logistic回归分析。结果两组年龄、高血压病史、糖尿病史、既往脑梗死病史和LA的严重程度均有显著差异。多因素回归分析最终入选模型的变量是年龄、高血压病史、既往脑梗死病史和重度LA。结论高龄、高血压病史、既往脑梗死病史和重度LA,对LA是否伴智能障碍有独立的提示作用。     

LEUKOARAIOSIS IN STROKE PATIENTS

Pathogenesis of leukoaraiosis (LA) is not clearly understood and its significance in patients with stroke remains undetermined. In the Neurol­ogy Department of Ankara Hospital, computed tomography (CT) examination of brain was performed for various reasons in 288 patients. LA was detected in 178 patients by the use of brain CT. Patients with LA had a higher incidence of hypertension history (70.8%) when compared with the non-LA group (57.3%; p <. 05). There was no statistically significant difference in terms of sex, mean age, smoking, diabetes mellitus, history of cerebrovascular disease, cardiac failure, ischemic cardiac disease between patients with and without LA. We showed that LA is related to hypertension but not related to age, diabetes mellitus, or cardiac disease in our patient population.     

脑白质疏松患者的脑血管储备与心脑血管事件以及认知功能障碍的关系

目的 评估脑白质疏松（LA）的脑血管储备功能（CVR）,并探讨脑白质疏松与后期发生的心脑血管事件及认知功能障碍之间的关系.方法 将连续入组神经内科门诊和住院的128例患者,根据MRI结果分为LA组和对照组,并按照LA的严重程度,将LA组分为轻度组、中度组、重度组.通过屏气诱发高碳酸血症,行经颅多普勒检测大脑中动脉血流速度变化并计算屏气指数（BHI）以评估脑血管储备功能.随访1年,主要终点事件为首次非致死性或者致死性卒中,并采用简明精神状态量表（MMSE）和蒙特利尔认知评估量表（MoCA）评估认知功能.结果 LA组与对照组比较,LA中、重度组的BHI值明显低于对照组（P＜0.05）.LA重度组血管性认知功能障碍的发生率明显高于对照组（P＜0.05）.而轻、中度组与对照组之间发生血管性认知功能障碍的比例差异无统计学意义.在随访期间,分别有16例LA组患者（20.51％）和2例对照组患者（4.0％）出现卒中（P＜0.01）.LA组出现11例急性脑梗死和5例出血性卒中,对照组出现1例脑梗死和1例出血性卒中.与对照组比较,LA组发生脑梗死的几率明显增加（P＜0.05）;而两组发生脑出血的几率差异无统计学意义（P＞0.05）.发生冠心病的风险明显升高（P＜0.05）.进一步比较,LA重度组发生急性脑梗死和中重度组发生冠心病的比例显著增高.两组总死亡率相似,LA组有2例死亡,对照组有1例,差异无统计学意义（P＞0.05）.结论 LA患者认知障碍明显高于非LA人群,且1年内发生缺血性脑卒中和冠心病的比例也高于非LA人群.脑白质疏松是影响CVR的危险因素,检测CVR可能预测脑白质疏松的严重程度及其发生心脑血管事件和认知功能障碍的可能性大小.     

Leuko-araiosis and stroke: a case-control study

Objective – Association of leuko-araiosis (LA) with certain risk factors has been reported in Western patients. This is a case-control study to determine the risk factors and the type of stroke associated with LA in Saudi patients. Design and setting - 398 consecutive Saudi patients with the diagnosis of stroke admitted over a 6-year period were evaluated for presence or absence of LA on cranial computed tomography. LA and non-LA groups were compared with regards to the presence of certain risk factors such as type of stroke, age, brain atrophy, systemic hypertension and history of cardiac disease or diabetes mellitus. The odds ratio and its 95% confidence interval (CI) were used to estimate the strength of association between the different parameters. Results – The mean age in the LA group was 67.8±8.5 years as compared to 61.2±13.2 years in the non-LA group. No patient younger than 40 years had LA on CT. Incidence of LA increased with age. Forty-seven percent of the LA group were over 70 years of age compared to 31 % of the non-LA group (OR=2, CI 1.26–3.15). Generalized atrophy was detected in 40% of patients with LA compared to 20% of non-LA group (OR 2.7, CI 1.65–4.39). Sixty-nine percent of patients in the LA group had lacunar infarct compare to 39% in the non-LA group (OR 3.4, CI 2.15–5.59). The difference was not significant between the two groups in relation to the frequency of cerebral hemorrhage or larger infarcts. Systemic hypertension was also significantly associated with the presence of LA (OR 2.15, CI 1.34–3.43). Conclusion – LA is associated mainly with lacunar infarcts, cerebral atrophy, systemic hypertension and advanced age in Saudi patients.     

脑白质疏松症患者认知功能与海马代谢关系的研究

目的探讨脑白质疏松症患者认知损害与海马代谢间的关系。方法对108例性别、受教育程度和脑血管病危险因素相匹配且有记忆力减退主诉的患者进行神经心理学评价,通过氢质子磁共振波谱测量左侧海马区N-乙酰天冬氨酸/肌酸、肌醇/肌酸、胆碱复合物/肌酸,以及谷氨酸和谷氨酰胺复合物α峰/肌酸比值,以观察与记忆相关脑区的代谢物变化。结果脑白质疏松症组患者简易智能状态检查量表(24.00)和蒙特利尔认知评价量表(16.50)中位数评分低于对照组(27.00和21.00),组间差异有统计学意义(均P=0.000);其中以视觉执行能力(1.00:3.00)、注意力(4.00:5.00)、语言(1.00:2.00)、延迟回忆(0.00:2.00)等项评分降低最为显著(P<0.05或P<0.01)。韦氏记忆量表中文修订版进一步测验显示,脑白质疏松症组患者瞬时记忆(5.06±2.86)和短时记忆(32.76±13.31)评分均显著低于对照组[(7.68±4.41)和(46.95±1481)],且差异具有统计学意义(P<0.05或p<0.01);左侧海马区N-乙酰天冬氨酸、肌醇、胆碱复合物与肌酸比值测定,两组差异无统计学意义(P>0.05)。结论脑白质疏松症引起的认知损害主要表现为视觉执行能力、注意力、语言及记忆(瞬时记忆和短时记忆)显著降低,未发现这一改变与左侧海马代谢变化有关。     

脑白质疏松与胰岛素抵抗和单核细胞趋化蛋白-1的关系

目的探讨脑白质疏松患者胰岛素抵抗(IR)与血浆单核细胞趋化蛋白-1(MCP-1)水平的关系。方法选择48例脑白质疏松患者,以30例健康者作为对照组。采用放射免疫法测定两组的空腹血胰岛素(FINS)水平,同时检测空腹血糖(FBG)、血脂,以稳态模型评估法(HOMA)评价胰岛素抵抗(HOMA-IR)。采用ELISA法测定血清MCP-1水平。结果脑白质疏松组的MCP-1水平高于健康对照组(P<0.01);脑白质疏松组FINS、HOMA-IR均高于健康对照组(P<0.01)。相关性分析显示脑白质疏松患者血清MCP-1水平与FPG、TC、LDL-C、血清胰岛素、HOMA-IR呈明显正相关(P<0.01)。结论脑白质疏松患者存在胰岛素抵抗,MCP-1与胰岛素抵抗密切相关。