中老年人血脂水平与脑白质病变发生的相关性  

The association of serum lipids with the presence of white matter lesions in middle-aged and elderly subjects

作　　者：陶永[1] 周华东[2] 王羚入[2] 王敏[2] 尹泽钢[2] Tao Yong Zhou Huadong Wang Lingru Wang Min Yin Zegang(Postgraduate School, Bengbu Medical College, Bengbu 233030, China)

机构地区：[1]蚌埠医学院研究生部,安徽省蚌埠市233030 [2]第三军医大学大坪医院神经内科

出　　处：《中华解剖与临床杂志》2016年第5期407-412,共6页Chinese Journal of Anatomy and Clinics

基　　金：国家自然科学基金（30870860）

摘　　要：目的：探讨中老年人血脂水平与脑白质病变（WML）发生之间的关系。方法纳入2012年6月—2013年6月第三军医大学大坪医院神经内科1282例年龄≥50岁的住院患者的临床资料进行回顾性分析,其中男606例、女676例,平均年龄（65.9＆#177;7.9）岁。所有患者行头颅 MRI 检查和血脂相关指标检测。在1282例患者中,WML 者781例,按照 WML 发生的部位分为脑室旁白质病变（PVWML）678例和深部白质病变（DWML）724例,两者均存在621例。按照 WML 严重程度分类：轻度 PVWML 469例（36.6%）、中度110例（8.6%）、重度99例（7.7%）,轻度 DWML 486例（37.9%）、中度147例（11.5%）、重度91例（7.1%）。应用 logistic 回归方法分析各血脂指标变化与WML 的关系。结果1282例分析显示,PVWML 组比无 PVWML 组比年龄更大（P 〈0.01）,男性更多（P 〈0.01）,卒中史、冠心病、高血压和糖尿病的患病率更高（P 值均 〈0.01）,血浆空腹血糖（FBG）浓度更高（P 〈0.05）。 DWML 组与无 DWML 组比较与 PVWML 类似,不同的是,两组间血浆 FBG 浓度差异无统计学意义（P 〉0.05）。血浆高密度脂蛋白胆固醇（HDL-C）、载脂蛋白（Apo） A-Ⅰ和 TC 水平在 PVWML 和 DWML 各级间的分布差异均有统计学意义（P 值均 〈0.05）；血浆低密度脂蛋白胆固醇和 Apo B 水平在 PVWML 的各级间的分布差异均有统计学意义（P 值均 〈0.05）。在调整年龄、性别、卒中史、冠心病、高血压和糖尿病后,血浆 HDL-C 和 Apo A-Ⅰ水平降低与 PVWML 和 DWML 的患病风险密切相关。结论中老年人血浆 HDL-C 和 Apo A-Ⅰ水平降低是 PVWML 和 DWML 的独立危险因素,可增大 WML 的患病风险。Objective To investigate the association of serum lipids with the presence of white matter lesions （WML） in middle-aged and elderly subjects. Methods From June 2012 to June 2013, 1 282 patients aged 50 years and older in the neurology department of Daping Hospital of Third Military Medical University were retrospectively enrolled. There were 606 males and 676 females. The mean age of the study subjects was （65. 9 ＆#177; 7. 9） years. All patients underwent MRI examination, fasting blood glucose and blood lipid analysis. In 1 282 patients, 781 patients were WML. According to the classification of WML, 678 patients of periventricular white matter lesions （PVWML） and 724 patients of deep white matter lesions （DWML）. Multivariate logistic regression analyses were performed to examine the association of each lipid index with WML. Results Analysis of 1 282 patients showed that patients with PVWML were older （P 〈 0. 01） and significantly higher proportion of male sex, hypertension, diabetes mellitus, prior stroke, and coronary heart disease（CHD）, and fasting blood glucose（FBG）（all P values 〈 0. 05）. The differences between patients with DWML and without DWML were similar to those with and without PVWML, except for levels of FBG （ P 〉 0. 05）. The distribution of serum total cholesterol （ TC）, high-density lipoprotein cholesterol（HDL-C）, and apolipoprotein A-Ⅰ（Apo A-Ⅰ） levels were significantly different between four grades of PVWML and DWML（ all P values 〈 0. 05）. The distribution of serum low-density lipoprotein cholesterol（LDL-C） and apolipoprotein B（Apo B） levels were significantly different between four grades of＆amp;nbsp;PVWML （all P values 〈 0. 05）. After adjustment for age, sex, prior stroke, coronary heart disease, hypertension, and diabetes, plasma levels of HDL-C and Apo A-Ⅰ were closely related to the risk of PVWML and DWML. Conclusions Decreased serum levels of HDL-C and Apo A-Ⅰ were independent risk factors associated with P

关 键 词：血脂异常 脑白质病变 高密度脂蛋白胆固醇 载脂蛋白A-Ⅰ 

分 类 号：R749.2[医药卫生—神经病学与精神病学]