高龄老年人不同程度脑白质损害的危险因素分析  

Risk factors analysis of white matter lesions of different degrees in the elderly aged 80 years and over

作　　者：王月菊[1] 侯宝元[1] 董凌燕[1] 李虹[1] 李建中[1] 

机构地区：[1]苏州大学附属第一医院老年病科,215006

出　　处：《中华老年医学杂志》2011年第4期285-290,共6页Chinese Journal of Geriatrics

基　　金：苏州市科技计划项目（2008ss08012）

摘　　要：目的 初步探讨不同程度脑白质损害（white matter lesions,WML）高龄患者的独立危险因素,为WML的进展提供预测依据.方法 根据Fazekas分级标准将151例74～93岁高龄老年人分为无白质损害组（对照组）、轻度脑白质损害组（轻度WML组）、中重度脑白质损害组（中重度WML组）,采用单因素方差分析和多因素Logistic回归分析三组间认知评分、血管危险因素、脑动脉硬化和脑血流动力学、神经解剖等各项指标之间差异及独立危险因素.结果 三组间单因素方差分析显示,认知评分（F=48.595,P=0.000）、高血压（x2=7.052,P=0.029）、吸烟（x2=19.476,P=0.000）、总胆固醇（F=3.086,P=0.049）、Crouse积分（F=3.968,P=0.021）及多项脑萎缩指标差异有统计学意义.轻度WML组患者与对照组间多因素Logistic回归分析结果表明,吸烟（OR 2.031,95%CI 1.244～1.317）、腔隙性梗死（LI）数目（OR 2.031,95%CI L 316～4.015）、总胆固醇（OR 1.610,95%CI 0.972～2.668）为独立危险因素（P＜0.05）;中重度WML组与轻度WML组间回归分析结果表明,认知评分（OR 0.276,95%CI 0.143～0.532）、吸烟（OR 2.262,95%CI 1.260～4.059）、大脑外侧裂比（OR 1.954,95%CI 1.013～3.768）为独立危险因素（P＜0.05）.中重度WML组患者与对照组间回归分析结果显示,认知评分（OR 0.091,95%CI 0.030～0.273）、尾状核指数（OR 2.511,95%CI 1.147～5.499）、Crouse积分（OR 2.304,95%CI 1.127～4.712）、LI数目（OR 2.200,95%CI 1.028～4.707）,为独立危险因素（P＜0.05）.结论 轻度WML患者在认知功能、脑动脉硬化及脑萎缩等方面改变不显著,而中重度WML患者表现显著的认知功能障碍、脑动脉硬化和脑萎缩.与对照组比较,认知评分、尾状核指数、Crouse积分、LI数目是中重度WML患者的独立危险因素.Objective To investigate the independent risk factors of cerebral white matter lesions （WML） of different degrees in the elderly aged 80 years and over,and provide the evidences for forecasting the prognosis of WML.Methods Brain magnetic resonance images （MRI） findings in 151 people aged 74 to 93 years were collected and analyzed.According to the severity of WML in brain MRI using the Fazekas Scale,the persons were divided into non-WML （control） group,mildWML （grade 1 WML） group and moderate-to-severe WML （grade 2 WML） group.The cognitive score,vascular risk factors,cerebral hemodynamic and arteriosclerotic index,and radiological features were compared among the three groups.Subsequent one-way ANOVA and multivariate logistic analysis were performed to determine the statistically significant factors and the independent risk factors among groups.Results The statistically significant factors with one-way ANOVA analysis among the three groups were cognitive performance （F = 48.595,P = 0.000）,hypertension （x2 =7.052,P=0.029）,cigarette history （x2 = 19.476,P= 0.000）,cholesterol （TC） （F= 3.086,P=0.049）,Crouse score （F=3.968,P=0.021） and multiple cerebral atrophy indexes.When compared with control group,cigarette history （OR 2.031,95%CI 1.244-1.317）,lacunar infarction （LI）numbers （OR 2.031,95%CI 1.316-4.015） and cholesterol （OR 1.610,95%CI 0.972-2.668） were independent risk factors in grade 1 WML group （all P〈0.05）.The independent risk factors between grade 1 and 2 WML group were cognitive performance （OR 0.276,95%CI 0.143-0.532）,cigarette history （OR 2.262,95% CI 1.260-4.059）,and sylvian fissure ratio （SFR） （OR 1.954,95% CI 1.013-3.768） （all P〈0.05）.The independent risk factors between the grade 2 WML group and control group were cognitive performance （OR 0.091,95%CI 0.030-0.273）,bicoudate ratio （BCR）（OR 2.511,95%CI 1.147-5.499）,Crouse score （OR 2.304,95%CI1.127-4.712）and LI numbers （OR 2.200,95%CI 1.028-4.707） �

关 键 词：脑损害 慢性 认知障碍 危险因素 动脉硬化 脑白质疏松症 

分 类 号：R743.3[医药卫生—神经病学与精神病学]