血清叶酸水平与脑白质高信号严重程度及伴发脑微出血的相关性  

Association of serum folate level with severity of white matter hyperintensity and presence of cerebral microbleeds

作　　者：钟根龙[1] 陈智才[1] 张睿婷 刘畅 周颖[1] 严慎强[1] 楼敏[1] 

机构地区：[1]浙江大学医学院附属第二医院神经内科,浙江杭州310009

出　　处：《浙江大学学报（医学版）》2017年第4期390-396,共7页Journal of Zhejiang University(Medical Sciences)

基　　金：国家自然科学基金(81471170;81622017)

摘　　要：目的:研究血清叶酸水平与脑白质高信号严重程度以及伴发脑微出血的相关性。方法:回顾性分析2011年7月至2016月2月在浙江大学医学院附属第二医院神经内科连续收集的脑白质高信号患者的临床资料。根据血清叶酸水平,将患者分为高叶酸组(≥15.68 nmol/L)、低叶酸组(6.8~<15.68 nmol/L)和叶酸缺乏组(<6.8 nmol/L)。在T2-Flair序列上使用Fazekas评分方法,将患者分为轻度脑白质高信号组(0~3分)和重度脑白质高信号组(4~6分);在磁敏感加权成像(SWI)序列上评估脑微出血。二元logistic回归分析血清叶酸水平与脑白质高信号严重程度、脑白质高信号伴脑微出血的相关性。结果:共有228例脑白质高信号患者纳入分析,其中重度脑白质高信号患者149例(65.35%),高叶酸组、低叶酸组和叶酸缺乏组的重度脑白质高信号患者比例分别为52.88%、73.33%和89.47%。二元logistic回归分析显示,叶酸水平与重度脑白质高信号相关,低叶酸(OR=2.109,95%CI:1.112~4.001,P<0.05)和叶酸缺乏的患者(OR=6.383,95%CI:1.168~34.866,P<0.05)更容易出现重度脑白质高信号。脑白质高信号伴脑微出血组的叶酸水平低于不伴脑微出血组(13.42 nmol/L与16.51 nmol/L,P<0.01),但二元logistic回归分析提示叶酸水平与脑微出血无独立相关性(P>0.05)。结论:血清叶酸水平低与重度脑白质高信号相关,但与脑微出血无独立相关性。Objective： To investigate the association of serum folate level with the severity of white matter hyperintensity （WMH） and presence of cerebral microbleeds （CMB）. Methods： Clinical data of WMH patients from the second affiliated Hospital, Zhejiang University school of Medicine during July 2011 and February 2016 were retrospectively reviewed. According to Fazekas score based on T2-Flair images, patients were classified into mild WMH （0 -3） and severe WMH （4 -6）. The presence of CMB was assessed on susceptibility weighted imaging （SWI）. Binary logistic analysis was conducted to identify the independent predictors for severe WMH and the presence of CMB. Results： Two hundred and twenty eight patients with WMH were included, among whom 149（65.35% ）had severe WMH. In patients with high folate （ ~〉 15.68 nmoL/L）, low folate （6. 8 - 15. 67 nmol/L ） and folate deficiency （ 〈 6. 8 nmol/L ）, the proportions of severe WMH were 52. 88%, 73. 33% and 89.47%, respectively. Binary logistic regression analysis revealed that compared with high folate group, severe WMH was more common in groups with low folate （OR = 2. 109, 95% CI： 1. 112 - 4.001 ,P 〈0.05） and folate deficiency （OR =6.383, 95% CI：I. 168 -34. 866, P 〈 0.05）. Eighty-eight （ 48.09% ） of 183 patients receiving SWI scan presented with CMB. Although the subjects with CMB had lower serum folate level than those without CMB（ 13.42 vs 16.51 nmol/L, P 〈0.01 ）, binary logistic regression analysis did not reveal the independent association between serum folate level and the presence of CMB after adjusting for hyperhomocysteinemia （ P 〉 O. 05 ）. Conclusion： Lower serum folate level is independently associated with severe WMH, but not with the CMB concurrence.

关 键 词：脑白质病 进行性多灶性 脑出血/病理生理学 叶酸 半胱氨酸 

分 类 号：R743.3[医药卫生—神经病学与精神病学]