摘要
目的探讨老年轻型卒中患者血浆同型半胱氨酸(Hcy)与血管周围间隙扩大(EPVS)之间的关系。方法回顾性连续纳入2019年3月至2020年1月在南京医科大学附属常州市第二人民医院神经内科住院治疗的轻型卒中(美国国立卫生研究院卒中量表评分≤3分)患者160例,年龄≥60岁。根据患者头部MRI评估患者的EPVS,测定患者血浆Hcy水平。根据血浆Hcy水平,分为Hcy正常组及升高组(Hcy≥15μmol/L),分析两组患者EPVS的分布情况,同时采用Spearman相关分析分析Hcy与EPVS等级的相关性。进一步依据EPVS的等级将患者分为EPVS轻、中重度两组,使用单因素和多因素Logistic回归分析方法分析影响EPVS严重程度的因素,分析血浆Hcy与EPVS、Hcy等级(依据四分位间距分成Q1~Q4级,以血浆Hcy Q1级为参照)与EPVS之间的关系。结果共纳入160例轻型卒中患者,其中Hcy正常组87例,Hcy升高组73例。Hcy升高组患者基底节、半卵圆中心的EPVS等级均高于Hcy正常组(Z=-3.264,P=0.001;Z=-2.282,P=0.023)。Spearman相关分析表明,基底节区及半卵圆中心区EPVS的等级均与Hcy水平呈正相关(r=0.301,P<0.001;r=0.199,P=0.012)。根据患者EPVS的部位和程度分为基底节区轻度53例、中重度107例及半卵圆中心区轻度66例、中重度94例。基底节区及半卵圆中心区EPVS的单因素及多因素Logistics回归分析结果表明,高水平血浆Hcy仅是基底节区EPVS的独立危险因素(OR=1.061,95%CI:1.007~1.119;P=0.027),血浆Hcy等级是基底节区EPVS的独立危险因素(OR=1.440,95%CI:1.055~1.966;P=0.022),Hcy Q4级明显增加基底节区EPVS的发生风险(OR=3.049,95%CI:1.111~8.366;P=0.030)。结论高水平血浆Hcy是老年轻型卒中患者基底区节EPVS出现的独立危险因素,提示血浆Hcy在老年轻型卒中患者EPVS的发生发展过程中具有重要意义。
Objective To explore the relationship between plasma homocysteine(Hcy)and enlarged perivascular clearance(EPVS)in elderly patients(≥60 years)with mild stroke.Methods From March 2019 to January 2020,patients with mild stroke(National Institutes of Health Stroke Scale Score≤3 points)and who were hospitalized in the Department of Neurology of Changzhou Second People′s Hospital Affiliated to Nanjing Medical University were enrolled consecutively.Patient′s EPVS grades were evaluated according to brain MRI,and their plasma Hcy level were tested.According to the plasma Hcy level,patients were divided into normal Hcy group and elevated Hcy group(Hcy≥15μmol/L).The distribution of EPVS in the two groups of patients was analyzed.At the same time,Spearman correlation analysis was used to analyze the correlation between Hcy and EPVS grade.According to the EPVS grade,the patients were divided into two groups:mild EPVS group and moderate to severe EPVS group.Univariate and multivariate logistic regression were used to analyze the factors influencing EPVS severity.The relationship between plasma Hcy and EPVS,and the relationship between Hcy grade(divided into Q1-Q4 grades according to the interquartile spacing,with plasma Hcy grade Q1 as the reference)and EPVS were analyzed.Results A total of 160 mild stroke patients were included,including 87 cases in the normal Hcy group and 73 cases in the elevated Hcy group.The EPVS grades of basal ganglia and semi-oval in patients with elevated Hcy group were higher than those in Hcy normal group(Z=-3.264,P=0.001;Z=-2.282,P=0.023).Spearman correlation analysis revealed the grades of basal ganglia and semi-ovale EPVS were positively correlated with Hcy(r=0.301,P<0.001;r=0.199,P=0.012).According to the location and degree of EPVS,53 patients had mild EPVS and 107 patients had moderate to severe EPVS in the basal ganglia region;66 cases had mild EPVS and 94 cases had moderate to severe EPVS in the semi-ovale region.Further univariate and multivariate logistic regression analysis revealed that high grade plasma Hcy was independent risk factor for EPVS only in the basal ganglia region(OR,1.061,95%CI 1.007-1.119;P=0.027).Hcy grade was still an independent risk factor for EPVS in the basal ganglia(OR,1.440,95%CI 1.055-1.966;P=0.022).Hcy Q4 significantly increased the occurrence risk of EPVS in the basal ganglia(OR,3.049,95%CI 1.111-8.366,P=0.030).Conclusions High plasma Hcy is an independent risk factor for EPVS in basal ganglia of aged patients with mild stroke.It suggests that Hcy plays an important role in the occurrence and development of EPVS of aged patients with mild stroke.
作者
汤晓强
马翼
黄宽宽
Tang Xiaoqiang;Ma Yi;Huang Kuankuan(Department of Neurology,Changzhou Second People's Hospital Affiliated to Nanjing Medical University,Changzhou 213164,China;不详)
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2020年第12期746-753,共8页
Chinese Journal of Cerebrovascular Diseases
基金
国家自然科学基金面上项目(81671284)
江苏省卫生健康委面上项目(H2019051)
南京医科大学科技发展基金(2015NJMUZD086)。
关键词
血管周围间隙扩大
同型半胱氨酸
卒中
轻型卒中
脑小血管病
Enlarged perivascular clearance
Homocysteine
Stroke
Mild stroke
Cerebral small vessel disease
