行走不稳伴叶酸缺乏患者病变特征研究  

Study on the characteristics of pathological changes in patients with unstable walking and folic acid deficiency

作　　者：余爱勇 赵迎春[1] 陈晟[2] 张瑜[1] 潘晓春 彭亮 娄晓丽[4] 孙建军[5] 赵玉武[6] YU Aiyong;ZHAO Yingchun;CHEN Sheng(Department of Neurology,Song Jiang Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Preparatory Stage,Shanghai 201699,China)

机构地区：[1]上海交通大学医学院附属松江医院(筹)神经内科,上海201699 [2]上海交通大学医学院附属瑞金医院神经内科,上海200025 [3]上海交通大学医学院附属松江医院(筹)检验科,上海201699 [4]上海交通大学医学院附属松江医院(筹)中心实验室,上海201699 [5]上海市公共卫生临床中心感染与免疫科,上海201052 [6]上海交通大学附属第六人民医院神经内科,上海200233

出　　处：《中风与神经疾病杂志》2020年第11期1021-1026,共6页Journal of Apoplexy and Nervous Diseases

基　　金：上海市松江区科学技术攻关项目(No.15SJGG30)。

摘　　要：目的搜集一组以行走不稳为主要表现、合并低叶酸血症,总结其临床特征。方法将叶酸<3.1 IU/ml者,未合并脑血管病者,首发症状表现为“行走不稳”者54例,列为行走不稳首发表现叶酸缺乏组;将叶酸<3.1 IU/ml、合并有脑血管病,列为叶酸降低合并脑血管病对照组,共129例。比较两组患者基线资料特征、生化代谢资料特征、头颅MRI脑内缺血灶分布特征,并进行Logistic多因素回归分析。结果行走不稳首发表现叶酸缺乏组发病时间为(7.56±8.78)d,高于叶酸缺乏合并脑血管病对照组(5.19±6.87)d,t=4.586,P=0.001。行走不稳首发表现叶酸缺乏组发病年龄为(77.11±9.97)岁,高于叶酸缺乏合并脑血管病对照组(73.30±12.42)岁,t=2.906,P=0.022。行走不稳首发表现叶酸缺乏组同型半胱氨酸(19.88±9.00),低于叶酸缺乏合并脑血管病对照组(30.38±59.77),t=2.938,P=0.021。行走不稳首发表现叶酸缺乏组脑叶缺血灶(41.67%)高于对照组(33.72%),χ^2=6.254,P=0.012。行走不稳首发表现叶酸缺乏组,大脑半球的缺血灶大多数呈点状独立分布;叶酸缺乏合并脑血管病对照组,大脑半球缺血灶大多数融合成条线状、条带状,边界模糊不清的病灶。以行走不稳首发表现的叶酸缺乏组作为因变量,二元logistic多因素回归分析,提示脑叶缺血灶的OR=2.311,95%CI 1.174~4.569,P=0.025。结论以行走不稳为表现、合并叶酸缺乏的患者可能具有起病时间较长、发病年龄较高、同型半胱氨酸水平升高不显著的特点,头颅MRI检查提示额叶、颞叶、顶叶的脑叶缺血灶数量多、呈点状独立分布的特征。Objective A group of patients with instability of walking as the main manifestation and combined with hypofolateemia were collected and their clinical characteristics were summarized.Methods 54 patients with folic acid<3.1 IU/ml,without cerebrovascular disease,whose first symptom manifested as"walking instability"were classified as the first group with folic acid deficiency in walking instability.Folic acid<3.1 IU/ml combined with cerebrovascular disease was listed as the control group of folic acid reduction combined with cerebrovascular disease,a total of 129 patients.The characteristics of baseline data,biochemical metabolism data,and brain MRI brain ischemic lesion distribution were compared between the two groups,and Logistic multivariate regression analysis was performed.Results The onset of folic acid deficiency in the onset of walking instability was(7.56±8.78)days,which was longer than the folic acid deficiency combined cerebrovascular disease control group at(5.19±6.87)days,t=4.586,P=0.001.The onset age of folic acid deficiency in the first manifestation of walking instability was(77.11±9.97)years,which was higher than the folic acid deficiency combined cerebrovascular disease control group at(73.30±12.42)years,t=2.906,P=0.022.The homocysteine in the folic acid deficiency group at the first manifestation of unstable walking was(19.88±9.00),which was lower than the folic acid deficiency combined with cerebrovascular disease control group(30.38±59.77),t=2.938,P=0.021.Focal deficiencies in the folic acid-deficient group at the onset of walking instability were higher(41.67%)than in the control group(33.72%),χ^2=6.254,P=0.012.Instability of walking was first manifested in the folic acid-deficient group,and most of the ischemic foci in the cerebral hemisphere were spot-shaped and independent.Folate deficiency combined with cerebrovascular disease control group,most of the cerebral hemisphere ischemic lesions were fused into linear,band-shaped lesions with blurred borders.Using the folic acid deficienc

关 键 词：叶酸 脑缺血 行走不稳 

分 类 号：R743[医药卫生—神经病学与精神病学]