60岁以上老年人颈动脉粥样硬化与脑白质病变的相关性研究

目的 探讨60岁以上老年人颈动脉粥样硬化和脑白质病变(WML)的相关性。方法 回顾性分析2012年4月—2014年3月第三军医大学大坪医院神经内科459例住院患者的临床和影像学资料。患者年龄均≥60岁,均行MRI及CTA检查。依据MRI检查结果将患者分为WML组和无WML组,对患者临床资料进行组间对比;参照NASCET标准、依据CTA检查结果对患者是否存在颈动脉粥样硬化及其狭窄程度进行评估,并采用logistic回归分析患者颈动脉粥样硬化发病率、狭窄程度及斑块性质与WML 发生的关系。结果 与无WML组(216例)相比,WML组(243例)年龄较高,且吸烟、饮酒、高血压、糖尿病、冠心病、血脂异常、高尿酸血症及颈动脉粥样硬化的比例较高(P值均＜0.05)。logistic回归分析显示年龄、吸烟、高血压、糖尿病、血脂异常及颈动脉粥样硬化为WML的危险因素(P值均＜0.05)。调整其他危险因素的影响后,颈动脉粥样硬化的狭窄程度和WML仍无明显相关性(P值均＞0.05)。颈动脉钙化斑块、脂质斑块、混合斑块的分布在WML组和无WML组间差异有统计学意义(χ²=5.041,P＞0.05)。调整其他危险因素的影响后,脂质斑块与WML正相关(P＜0.05,OR=1.84,95%CI 1.47~2.98),混合斑块和WML无明显相关性(P＞0.05,OR=1.97,95% CI 0.99~2.97)。结论 颈动脉粥样硬化增加WML发生的风险。颈动脉狭窄程度与WML的发生无明显相关性。颈动脉粥样硬化的斑块性质与WML有相关性,脂质斑块是WML发生的危险因素。

The relationship between carotid atherosclerosis and cerebral white matter lesions in the elderly over 60 years old

Objective To investigate the association between carotid atherosclerosis and white matter lesions (WML).Methods A cohort of 459 Chinese Han subjects who were over 60 years old with MRI and CTA examination at the same time from April 2012 to March 2014 in the Department of Neurology of Daping Hospital were enrolled and underwent a retrospective analysis. According to the MRI results, all subjects were divided to WML group and non-WML group. All the patients were evaluated with carotid atherosclerosis refer to the NASCET standard. The clinical data of all the subjects were collected and analyzed. The correlations of the incidence of WML with carotid atherosclerosis, degree of stenosis and plaque character were analyzed by logistic associated factor.Results Compared with the non-WML group(n=216), WML group(n=243) had a higher age, and the proportion of smoking, drinking, hypertension, diabetes, coronary heart disease, dyslipidemia, hyperuricemia, carotid atherosclerosis were obviously higher(all P values<0.05). Logistic regression analysis showed that age, smoking, hypertension, diabetes, dyslipidemia and carotid atherosclerosis were risk factors for WML (all P values<0.05). After adjustment for other risk factors, there was still no significant association between the grade of stenosis and WML (all P values＞0.05). The character of carotid atherosclerosis plaque between WML group and non-WML group was significantly different (χ²=5.041, P＞0.05). After adjustwent by risk factors, lipide plague was positive related to WML (P＜0.05, OR=1.84, 95%CI 1.47-2.98), and there was no significant difference in the distribution of mixed plaque between WML group and non-WML group(P＞0.05, OR=1.97, 95%CI 0.99-2.97).Conclusions Carotid atherosclerosis increases the risk of WML. The extent of stenosis is not associated with WML. The carotid atherosclerosis plaque type is associated with WML, lipide plaque increases the risk of WML.