血浆同型半胱氨酸水平与脑小血管病患者脑白质病变的研究  

The Study of Plasma Homocysteine level and White Matter Lesions in Patients with Cerebral Small Vascular Disease

作　　者：黄淑云[1] 章成国[1] 张薇平[1] 卢健聪[1] 林碧清[1] 黄嘉星[1] 谢海群[1] 

机构地区：[1]佛山市第一人民医院,528000

出　　处：《中国老年保健医学》2018年第1期56-59,共4页Chinese Journal of Geriatric Care

基　　金：广东省自然基金(S2012010009715);佛山市科技局立项(201106170)

摘　　要：目的探讨血浆同型半胱氨酸(Hcy)水平与脑小血管病(CSVD)患者脑白质病变的相关性,及Hcy对CSVD的易损脑区部位。方法纳入CSVD患者263例(其中男性152例),对所有患者完成头颅核磁共振(MRI)及Hcy等检查和检验,完成50例患者的弥散张量成像(DTI)检查,测量其海马、丘脑、前后扣带回、胼胝体、额顶枕颞叶白质等部位的mean ADC和mean FA。采用ARWMCs分级方法评估脑白质损害程度。对Hcy与ARWMCs评分的关系进行多因素回归分析;Hcy与多处脑区的mean ADC与mean FA值的关系分析采用单因素分析和t检验。结果调整年龄、高血压病史、糖尿病病史、空腹血糖、收缩压和总胆固醇,Hcy与ARWMCs评分多因素回归分析结果:β为2.51,95%CI为0.12~4.91,P=0.0413;单因素分析发现,Hcy与左前扣带回及胼胝体膝损害有密切关系,左前扣带回:β为-0.71,95%CI为-1.36^-0.05,P=0.0409;胼胝体膝:β为1.79,95%CI为0.83~2.75,P=0.0007。Hcy分组比较,高水平Hcy组与低水平Hcy组相比,左前扣带回mean FA及胼胝体膝mean ADC差异有统计学意义,左前扣带回,P=0.044;胼胝体膝P=0.026。结论 Hcy与脑小血管病患者脑白质损害关系密切,随Hcy水平的升高,脑白质损害加重,且以胼胝体膝部损害最明显。Objectives To study the relationship between homocysteine level and white matter hyperintensity in patients with with cerebral small vascular disease,and the vulnerable site. Methods 263 patients with CSVD were put in the research,152 patients were men. All patients were completed skull MRI 、Hcy and relevanted inspection and testing; 50 cases patients were completed diffusion tensor imaging（ DTI）. ARWMCs were used for evaluating the extent of WMH. Multivariate regression analysis,univariate regression analysis and t test were used for statistical analysis. Results After adjusted age,the history of hypertension and diabetes,fastingglucose,systolic blood pressure and total cholesterol,multivariate regression analysis for the Hcy and ARWMCs score wereβ（ 95%CI） P：（ 2. 51,0. 12 - 4. 91,P = 0. 0413）; DTI analysis found that Hcy associated with the injury of left anterior cingulate and corpus callosum knee,left anterior cingulate gyrus β（ 95%CI） P：（-0. 71,-1. 36 - 0. 05,0. 0409）; Corpus callosum knee β（ 95%CI） P ：（ 1. 79,0. 83 - 2. 75,0. 0007）. The Hcy Secondecomparison,left anterior cingulate gyrus,P = 0. 044; Corpus callosum knee P= 0. 026,the difference was statistically significant. Conclusion Hcy closely associated with WMH in patients with CSVD,and as the increasing of Hcylevels,the WMH was aggravating; The corpus callosum knee was the most obvious in the damage.

关 键 词：同型半胱氨酸 脑白质高信号 年龄相关脑白质损害评分 弥散张量成像 

分 类 号：R743[医药卫生—神经病学与精神病学]