老年人缺血性脑白质疏松分析

Analysis of related factors in elderly patients of different degree ischemic leukoaraiosis

目的探究不同年龄段老年人不同程度缺血性脑白质疏松(LA)的患病率,及其与同型半胱氨酸(Hcy)间的相关性,分析LA的危险因素。方法选择经磁共振成像(MRI)确诊的老年(>60岁)LA患者161例,按年龄分组,61～70岁组,>70～80岁组,>80岁组,测定每组患者Hcy水平;依据患者LA评分,分为轻、中、重度,比较不同年龄组间LA患病率,损害程度及其与Hcy水平间的关系,并对老年LA患者相关危险因素进行单因素和多因素分析。结果 LA患病率61～70岁组78.6%(33/42),中重度比率28.6%(12/42),>70～80岁组LA患病率89.5%(51/57),中重度比率61.4%(35/57),>80岁组的LA患病率96.8%(60/62),中重度比率82.3%(51/62),>70～80岁组及>80岁组老年患者,LA患病率的比例及损害程度显著高于61～70岁组(P<0.05);随着年龄增长,老年患者血浆Hcy水平增高,61～70岁组Hcy(17.896±7.026)μmol/L,>70～80岁组Hcy(21.723±7.897)μmol/L,>80岁组Hcy(25.548±8.896)μmol/L(P<0.05);Logistic回归分析显示年龄、高血压、高Hcy血症及颈动脉粥样硬化与老年缺血性脑白质疏松相关。结论老年患者随着年龄增长,脑白质疏松损害加重,血浆Hcy水平升高,年龄、高血压和血浆Hcy水平升高是老年缺血性LA独立危险因素。

Objective To explore the prevalence of ischemic leukoaraiosis（LA） in different elderly ages people,and the correlation between LA and homocysteine（Hcy）;to analyze the risk factors for LA.Methods 161 elderly patients（60 years old） were divided into three groups according to ages,61-70 years old,〉70-80 years old,80 years old,whose LA were confirmed with MRI.Hcy was detected,and LA scale was scored in the three groups.According to the scores,LA patients were classified into 0-3 grades（light,medium and severe degree）,2 and 3 grades were medium-severe group.LA damage degree and Hcy level as well as the risk factors in elderly LA patients were evaluated with single-factor analysis and multiplicity.Results In 61-70 years old,in 70-80 years old and 80 years old groups,the prevalences of LA were 78.6%（33/42）,89.5%（51/57）,and 96.8%（60/62）.The medium-severe ratio in those groups were 28.6%（12/42）,61.4%（35/57） and 82.3%（51/62）.Both prevalences and medium-severe ratio in 70-80 years old and 80 years old groups were significantly higher than those in 61-70 years old group（P〈0.05）.In 61-70 years old,70-80 years old and 〉80 years old groups,the Hcy was（17.896±7.026） μmol/L,（21.723±7.897） μmol/L and（25.548±8.896） μmol/L,plasma Hcy levels were significantly higher with age increase（P〈0.05）.A single-factor and multi-logistic regression analysis displayed that age,hypertension,high Hcy and carotid artery atherosclerosis were correlated in elderly patients of ischemic LA.Conclusion The degree of white matter lesions increases and plasma Hcy level raises with age in elderly patients of ischemic LA.Age,hypertension,high Hcy are independent risks for elderly LA patients.