脑白质疏松症患者脑血流自动调节研究
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摘要
目的探讨脑白质疏松(LA)与脑血流自动调节有无相关性以及脑白质疏松症的危险因素。方法选择181例神经内科住院患者,根据患者入院后颅脑MRI分析,以Fazekas量表将入组患者按照LA的严重程度进行分级分组(LA0级组、LA1级组、LA2级组、LA3级组),并用经颅多普勒行卧立位脑血流检测。搜集每位患者的年龄、性别、高血压病、糖尿病、冠心病、吸烟、饮酒、血脂、血小板、空腹血糖、白蛋白、球蛋白、颈动脉狭窄及内中膜厚度等指标进行调查评估,用SPSS17.0统计分析软件进行分析。结果 Spearman检验可知,脑白质疏松与脑血流自动调节呈明显正相关关系(P<0.05)。年龄、高血压、脑血流调节功能受损、颈动脉狭窄及内中膜厚度是脑白质疏松发病的影响因素(P<0.05),Logistic回归分析可知,年龄、高血压、颈动脉狭窄、脑血流调节功能受损是脑白质疏松发病的独立危险因素(P<0.05)。结论脑白质疏松症与脑血流调节功能呈正相关,年龄、高血压、颈动脉狭窄、脑血流调节功能受损是脑白质疏松发病的独立危险因素。临床可通过对上述危险因素进行积极干预防治脑白质疏松。
Objective To investigate the correlation between leukoaraiosis and cerebral blood flow autoregulation and the risk factors of leukoaraiosis.Methods One hundred and eighty-one patients were enrolled.All the patients were underwent brain MRI after hospitalized.According to the grading of severity of leukoaraiosis using the fazekas scale,the patients were classified as group LA0,LA1,LA2,LA3.The function of cerebral blood flow regulation were measured with transcranial Doppler.Picking up informations about age,sex,hypertension,diabetes,coronary disease,smoking,alcohol consumption,blood lipids,blood cells,fasting glucose,white protein,globin,carotid artery stenosis,intima media thickness of each patient.The data was analyzed with SPSS17.0 software.Results Spearman tese showed that the leukoaraiosis were significantly positively correlated with the cerebral autoregulation(P<0.05).Age,hypertension,the cerebral blood flow autoregulation were decreased,carotid artery stenosis and intima media thickness were the factors affecting the incidence of leukoaraiosis(P<0.05).Logistic regression analysis showed that age,hypertension,carotid artery stenosis and the cerebral blood flow autoregulation were decreased were the independent risk factors for the onset of leukoaraiosis(P<0.05).Conclusion The leukoaraiosis were significantly positively correlated with the cerebral autoregulation.Age,hypertension,carotid artery stenosis and the cerebral blood flow autoregulation were decreased were the independent risk factors for the onset of leukoaraiosis.The prevention and treatment of leukoaraiosis can be carried out by the active intervention of the above risk factors.
Objective To investigate the correlation between leukoaraiosis and cerebral blood flow autoregulation and the risk factors of leukoaraiosis.Methods One hundred and eighty-one patients were enrolled.All the patients were underwent brain MRI after hospitalized.According to the grading of severity of leukoaraiosis using the fazekas scale,the patients were classified as group LA0,LA1,LA2,LA3.The function of cerebral blood flow regulation were measured with transcranial Doppler.Picking up informations about age,sex,hypertension,diabetes,coronary disease,smoking,alcohol consumption,blood lipids,blood cells,fasting glucose,white protein,globin,carotid artery stenosis,intima media thickness of each patient.The data was analyzed with SPSS17.0 software.Results Spearman tese showed that the leukoaraiosis were significantly positively correlated with the cerebral autoregulation(P<0.05).Age,hypertension,the cerebral blood flow autoregulation were decreased,carotid artery stenosis and intima media thickness were the factors affecting the incidence of leukoaraiosis(P<0.05).Logistic regression analysis showed that age,hypertension,carotid artery stenosis and the cerebral blood flow autoregulation were decreased were the independent risk factors for the onset of leukoaraiosis(P<0.05).Conclusion The leukoaraiosis were significantly positively correlated with the cerebral autoregulation.Age,hypertension,carotid artery stenosis and the cerebral blood flow autoregulation were decreased were the independent risk factors for the onset of leukoaraiosis.The prevention and treatment of leukoaraiosis can be carried out by the active intervention of the above risk factors.
引文
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[2] 张晖,王勇,耿左军,等.超高场强磁共振扩散张量成像对脑白质疏松症的诊断价值[J].中华老年心脑血管病杂志,2012,14(10):1028～1031.
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[8] Ryberg C,Rostrup E,Paulson OB,et al.Corpus callosum atrophy as a predictor of age-related cognitive and motor impairment:a 3-year follow-up of the LADIS study cohort [J].J Neurol Sci,2011,307(1-2):100～105.
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[12] Grueter BE,Schulz UG.Age-related cerebral white matter disease(leukoaraiosis):a review[J].Postgrad Med J,2012,88(1036):79～87.
[13] Yu X,Wang G,Zhan J,et al.Risk factors of pure leukoaraiosis and the association with preclinical carotid atherosclerosis[J].Atherosclerosis,2018,275:328～332.
[14] 齐冬,王春雪,贾茜,等,糖代谢异常与LA相关性初步研究[J].中国卒中杂志,2010,5(4):281～285.
[15] Feng C,Bai X,Xu Y,et al.Hyperhomocysteinemia associates with small vessel disease more closely than large vessel disease[J].Int J Med Sci,2013,10(4):408～412.
[16] 张爱娟,王素珍,王金红.脑白质疏松危险因素的回归分析[J].中国康复理论与实践,2012,18(11):1069～1070.
[17] 杨茜,陈红.脑白质疏松症的研究进展[J].医学综述,2013,19(8):1375～1377.
[18] 刘洋,张爱娟,高琳芝,等.多发白质微梗死与脑白质疏松的相关性[J].潍坊医学院学报,2016,38(6):418～420.
[19] Fu J,Tang J,Han J,et al.The reduction of regional cerebral blood flow in normal-appearing white matter is associated with the severity of white matter lesions in elderly:a xeon-CT study[J].Plos One,2014,9(11):e1128～e1132.
[20] Huynh TJ,Murphy B,Pettersen JA,et al.CT perfusion quantification of small-vessel ischemic severity[J].AJNR Am J Neuroradiol,2008,29(10):1831～1836.
[21] Engelhardt M,Pfadenhauer K,Zentner J,et al.Impaired cerebral autoregulation in asymptomatic patients with carotid artery stenosis:comparison of cetazolamide-SPECT and transcranial CO(2)-dopplersonography[J].Zentralbl Chir,2004,129(3):178～182.
[22] Berman SE,Wang X,Mitchell CC,et al.The relationship between carotid artery plaque stability and white matter ischemic injury[J].Neuroimage Clin,2015,22(9):216～222.
[2] 张晖,王勇,耿左军,等.超高场强磁共振扩散张量成像对脑白质疏松症的诊断价值[J].中华老年心脑血管病杂志,2012,14(10):1028～1031.
[3] Lassen NA.Cerebral blood flow and oxygen consumption in man[J].Physiol Rev,1959,39(2):183～238.
[4] De Leeuw FE,De Groot JC,Achten E,et al.Prevalence of cerebral white matter lesions in elderly people:a population based magnetic resonance imaging study.The rotterdam scan study[J].J Neurol Neurosur PS,2001,70(1):9～14.
[5] Wen W,Sachdev PS,Li JJ,et al.White matter hyperintensities in the forties:their prevalence and topography in an epidemiological sample aged 44-48[J].Hum Brain Mapp,2009,30(4):1155～1167.
[6] Helenius J,Hennenger N.Leukoaraiosis is burden significantly modulates the association between infarct volume and national institutes of health stroke scale in ischemic stroke[J].Stroke,2015,46(7):1857～1863.
[7] Kreisel SH,Blahak C,Bzner H,et al.Deterioration of gait and balance over time:the effects of age-related white matter change-the LADIS study [J].Cerebrovasc Dis,2013,35(6):544～553.
[8] Ryberg C,Rostrup E,Paulson OB,et al.Corpus callosum atrophy as a predictor of age-related cognitive and motor impairment:a 3-year follow-up of the LADIS study cohort [J].J Neurol Sci,2011,307(1-2):100～105.
[9] Firbank MJ,Teodorczuk A,van der Flier WM,et al.Relationship between progression of brain white matter changes and late-life depression:3-year results from the LADIS study[J].Br J Psychiatry,2012,201(1):40～45.
[10] Gilberti N,Gamba M,Premi E,et al.Leukoaraiosis is a predictor of futile recanalization in acute ischemic stroke[J].J Neurol,2017,264(3):448～452.
[11] Ryu WS,Woo SH,Schellingerhout D,et al.Stroke outcomes are worse with larger leukoaraiosis volumes[J].Brain,2017,140(1):158～170.
[12] Grueter BE,Schulz UG.Age-related cerebral white matter disease(leukoaraiosis):a review[J].Postgrad Med J,2012,88(1036):79～87.
[13] Yu X,Wang G,Zhan J,et al.Risk factors of pure leukoaraiosis and the association with preclinical carotid atherosclerosis[J].Atherosclerosis,2018,275:328～332.
[14] 齐冬,王春雪,贾茜,等,糖代谢异常与LA相关性初步研究[J].中国卒中杂志,2010,5(4):281～285.
[15] Feng C,Bai X,Xu Y,et al.Hyperhomocysteinemia associates with small vessel disease more closely than large vessel disease[J].Int J Med Sci,2013,10(4):408～412.
[16] 张爱娟,王素珍,王金红.脑白质疏松危险因素的回归分析[J].中国康复理论与实践,2012,18(11):1069～1070.
[17] 杨茜,陈红.脑白质疏松症的研究进展[J].医学综述,2013,19(8):1375～1377.
[18] 刘洋,张爱娟,高琳芝,等.多发白质微梗死与脑白质疏松的相关性[J].潍坊医学院学报,2016,38(6):418～420.
[19] Fu J,Tang J,Han J,et al.The reduction of regional cerebral blood flow in normal-appearing white matter is associated with the severity of white matter lesions in elderly:a xeon-CT study[J].Plos One,2014,9(11):e1128～e1132.
[20] Huynh TJ,Murphy B,Pettersen JA,et al.CT perfusion quantification of small-vessel ischemic severity[J].AJNR Am J Neuroradiol,2008,29(10):1831～1836.
[21] Engelhardt M,Pfadenhauer K,Zentner J,et al.Impaired cerebral autoregulation in asymptomatic patients with carotid artery stenosis:comparison of cetazolamide-SPECT and transcranial CO(2)-dopplersonography[J].Zentralbl Chir,2004,129(3):178～182.
[22] Berman SE,Wang X,Mitchell CC,et al.The relationship between carotid artery plaque stability and white matter ischemic injury[J].Neuroimage Clin,2015,22(9):216～222.