老年糖尿病腔隙性脑梗死患者脑白质疏松的影响因素  

Risk factors for leukoaraiosis in elderly diabetic lacunar cerebral infarction patients

作　　者：于玲[1] 杨磊[3] 刘东涛[2] 杨淑娜[3] 李悦[3] 顾华[4] 胡文立[3] 高珊[1] Yu Ling;Yang Lei;Liu Dongtao;Yang Shuna;Li Yue;Gu Hua;Hu Wenli;Gao Shan(Department of Endocrinology,Affiliated Beijing Chaoyang Hospital of Capital Medical University,Beijing 100043,China)

机构地区：[1]首都医科大学附属北京朝阳医院京西院区内分泌科,100043 [2]首都医科大学附属北京朝阳医院京西院区神经内科,100043 [3]首都医科大学附属北京朝阳医院神经内科 [4]首都医科大学附属北京朝阳医院放射科

出　　处：《中华老年心脑血管病杂志》2019年第6期622-625,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的探讨老年糖尿病腔隙性脑梗死患者脑白质疏松(LA)的影响因素。方法选择老年腔隙性脑梗死合并糖尿病患者207例,根据脑室旁LA严重程度分为中重度组119例和轻度组88例;又根据深部LA严重程度分为中重度组90例和轻度组117例,分别比较脑室旁和深部各组临床特征的差异,logistic回归分析影响LA程度的危险因素。结果脑室旁分组中,与轻度组比较,中重度组年龄更大[(71.36±7.13)岁vs (66.64±5.66)岁],脑卒中史比例(46.2%vs 17.0%)和同型半胱氨酸(Hcy)水平[(16.50±4.41)μmol/L vs (14.67±3.29)μmol/L]明显增高,吸烟比例(27.7%vs 50.0%)明显降低(P<0.01)。年龄、脑卒中史和Hcy水平增高为脑室旁中重度LA的独立危险因素。深部分组中,与轻度组比较,中重度组年龄更大[(71.84±7.10)岁vs (67.44±6.18)岁]、脑卒中史比例(50.0%vs 21.4%)和Hcy水平[(16.68±4.37)μmol/L vs (14.77±3.47)μmol/L]明显增高,高脂血症比例(15.6%vs 29.1%)和糖化血红蛋白(7.40%vs 7.90%)水平降低(P<0.05,P<0.01)。年龄,脑卒中史为脑深部中重度LA的独立危险因素。结论在脑室旁和深部LA区域,年龄和脑卒中史为老年糖尿病腔隙性脑梗死患者中重度LA的独立危险因素。Hcy水平增高为此类患者脑室旁中重度LA的独立危险因素。Objective To study the risk factors for leukoaraiosis(LA)in elderly diabetic lacunar cerebral infarction(DLCI)patients.Methods Two hundred and seven elderly DLCI patients were divided into mild LA group(n=88)and moderate-severe LA group(n=119)according to the severity of paraventricular LA and into mild LA group(n=117)and moderate-severe LA group(n=90)according to the severity of deep LA.The clinical characteristics of paraventricular LA and deep LA were compared between two mild LA groups and two moderate-severe LA groups.The risk factors for LA in elderly DCLI patients were analyzed by multivariate logistic regression analysis.Results The age was older,the incidence of cerebral stroke and serum Hcy level were significantly higher while the ratio of smokers was significantly lower in moderate-severe paraventricular LA group than in mild paraventricular LA group(71.36±7.13 vs 66.64±5.66,46.2%vs 17.0%,16.50±4.41μmol/L vs 14.67±3.29μmol/L,27.7%vs 50.0%,P<0.01).Multivariate logistic regression analysis showed that age,history of cerebral stroke and elevated serum Hcy level were the independent risk factors for severe paraventricular LA.The age was older,the incidence of cerebral stroke and serum Hcy level were significantly higher while the incidence of hyperlipidemia and serum HbA1 clevel were significantly lower in moderate-severe deep LA group than in mild deep LA group(71.84±7.10 vs 67.44±6.18,50.0%vs 21.4%,16.68±4.37μmol/L vs 14.77±3.47μmol/L,15.6%vs 29.1%,7.4%vs 7.9%,P<0.05,P<0.01).Multivariate logistic regression analysis showed that age and history of cerebral stroke were the independent risk factors for severe deep LA.Conclusion Age and history of cerebral stroke are the independent risk factors for moderate-severe deep LA while elevated serum Hcy level is the independent risk factor for moderate-severe paraventricular LA in elderly DLCI patients.

关 键 词：糖尿病 脑梗死 脑白质疏松症 高半胱氨酸 高脂血症 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R587.2[医药卫生—临床医学]