急性腔隙性脑梗死患者脑白质病变程度与血红蛋白水平的关系

目的探讨急性腔隙性脑梗死患者脑白质病变程度与血红蛋白(Hb)的相关性。方法回顾性收集2010年1月—2011年12月入住浙江大学医学院附属第一医院神经内科的急性腔隙性脑梗死患者175例。对所有患者均行头部MRI检查,根据Fazekas的标准,将脑白质病变分为脑室旁周围型(PVWMH)和深部白质型病变(DWMH),并对病变的程度进行评分(0～3分),其中>2分定义为重度病变。采用多因素Logistic回归分析的方法分析Hb水平与脑白质病变程度的相关性。结果①175例患者中,重度PVWMH病变者109例。单因素影响因素分析显示,与轻度病变者比较,重度病变者的年龄高,有卒中史、肾小球滤过率降低及Hb降低(贫血)患者所占的比率高。重度DWMH病变者84例;与轻度病变者比较,年龄高,有高血压史、卒中史、肾小球滤过率降低患者所占的比率高。上述指标比较差异均有统计学意义,均P<0.05。②多因素Logistic回归分析显示,除年龄、卒中史外,Hb降低是影响PVWMH严重程度的独立危险因素(OR=0.97,95%CI:0.946～0.996,P=0.026)。而影响DWMH严重程度的独立危险因素是年龄、高血压史及卒中史,与Hb水平无相关性。结论 Hb水平降低是影响重度PVWMH病变的独立危险因素。

Relationship between the severity of white matter lesions and hemoglobin level in patients with acute lacunar infarction

Objective To investigate the correlation between the severity of white matter lesions and hemoglobin（Hb） level in patients with acute lacunar infarction.Methods A total of 175 patients with acute lacunar infarction were collected retrospectively in the Department of Neurology,the First Affiliated Hospital of Zhejiang University School of Medicine from January 2010 to December 2011.All patients underwent head MR imaging scan.White matter lesions were divided into periventricular white matter hyperintensity（PVWMH） and deep white matter hyperintensity（DWMH） according to the Fazekas criteria,and the severity of lesions were scored（0 to 3）,in which 2 was define as severe lesion.Multivariate logistic regression analysis was used to investigate the correlation between the Hb levels and the severity of white matter lesions.Results ① Of the 175 patients,109 had severe PVWMH lesions.Single factor influencing factors analysis showed that the percentages of elder age,prior stroke,decreased glomerular filtration rate,and low Hb（anemia） were high in patients with severe lesions compared to those with mild lesions.Eighty-four patients had severe DWMH lesions.The percentages of elder age,history of hypertension,prior stroke,and decreased glomerular filtration rate were high in patients with severe lesions compared to those with mild lesions.There were statistically significant differences compared to the above indicators（P0.01 or P0.05）.②Multivariate logistic regression analysis showed that in addition to age and prior stroke,the decreased hemoglobin was an independent risk factor for affecting the severity of PVWMH（OR=0.97,95% CI： 0.946 to 0.996,P=0.026）,while the independent risk factors for affecting the severity of DWMH were age,history of hypertension and prior stroke,and they had no correlation with Hb levels.Conclusion The decreased Hb level is an independent risk factor for affecting severe PVWMH lesions.