血清维生素B_(12)水平与腔隙性脑梗死患者脑白质病变严重程度的关系研究

Relationship between Serum Vitamin B_(12) Level and Severity of Cerebral White Matter Lesion in Patients with Lacunar Infarction

目的探讨血清维生素B12水平与腔隙性脑梗死患者脑白质病变(WML)严重程度的关系。方法选取2012年1—10月我院收治的腔隙性脑梗死患者213例,检测其血压、血糖、血清维生素B12、血清胆固醇水平,进行颅脑MRI检查;分别采用Fazekas分级标准和Aharon-Peretz分级标准评价患者脑白质病变严重程度。相关性分析采用Spearman相关性分析,危险因素的分析采用等级多因素Logistic回归分析。结果 213例患者血清维生素B12水平为50～801 ng/L,中位数为301.82 ng/L;不同分级标准腔隙性脑梗死患者维生素B12水平比较,差异均有统计学意义(P<0.05)。Spearman相关分析结果显示,血清维生素B12水平与Fazekas标准中的脑室旁脑白质病变(PWML)总分(r=-0.416,P<0.05)及深部脑白质病变(DWML)评分(r=-0.299,P<0.05)、Aharon-Peretz分级标准(r=-0.271,P<0.05)均呈负相关。等级多因素Logistic回归分析显示:采用Fazekas分级标准评价PWML时,血清维生素B12水平/降低100单位〔OR=1.672,95%CI(1.419,1.869)〕和高龄〔OR=1.050,95%CI(1.026,1.076)〕对回归方程的影响有统计学意义(P<0.05);采用Fazekas分级标准评价DWML时,血清维生素B12水平/降低100单位〔OR=1.603,95%CI(1.307,1.961)〕和高龄〔OR=1.057,95%CI(1.023,1.092)〕对回归方程的影响有统计学意义(P<0.05);采用Aharon-Peretz分级标准时,血清维生素B12水平/降低100单位〔OR=1.374,95%CI(1.166,1.618)〕和高龄〔OR=1.047,95%CI(1.015,1.067)〕对回归方程的影响有统计学意义(P<0.05)。结论血清维生素B12水平与腔隙性脑梗死患者脑白质病变严重程度呈负相关,高龄和血清维生素B12水平/降低100单位是脑白质病变严重程度增加的危险因素。

Objective To investigate the relationship between serum vitamin B^2 （VitB^2） level and severity of white matter lesions （WML） in patients with lacunar infarction （LI）. Methods The levels of blood pressure, blood sugar, VitB12, serum cholesterol were determined, brain MRI performed in 213 LI in-patients. Fazekas rating scale and Aharon-Peretz rating scale were used to evaluate the severity of LI lesions. Spearman correlation analysis was used to do correlation analysis, grading multivariate Logistic regression to analyze the risk factors. Results The VitB12 levels of 213 patients were in the range of 50 - 801 ng/L, median 301.82 ng/L. There was significant difference in VitBl2 level between LI patients at different grades （P 〈 0.05）. By Spearman correlation analysis, VitB12 level was negatively correlated with periventricular white matter lesions （PWML） total score （ r = - 0. 416, P 〈 0. 05 ） and deep white matter lesions （DWML） rating in Fazekas rating scale （ r = - 0. 299, P 〈 0. 05 ）, and negatively with Aharon - Peretz rating scale （ r = - 0.271, P 〈 0. 05 ）. By grading multivariate Logis-tic regression analysis, decreased VitB12 [OR=1.672, 95%CI （1.419, 1. 869） ; OR=1.603, 95%CI （1. 307, 1.961）1 and increased age [ OR = 1. 050, 95% CI （ 1. 026, 1. 076） ; OR = 1. 057, 95% CI （ 1. 023, 1. 092） ] were risk factors for both periventricular and deep WMLs as per Fazekas rating scale （P 〈 0. 05 for both）. Decreased VitB12 [ OR = 1. 374, 95 % CI （1. 166, 1.618）1 and increased age [OR=1.047, 95%CI （1.015, 1.067）1 were risk factors for WML as per Aharon - Peretz rating scale （P 〈 0. 05 ）. Conclusion Results regarding the relationship between VitB,2 level and the severity of WML are consistent when using Fazekas or Aharon - Peretz rating scales to determine the severity of WML; VitB12 level is negatively correlated with severity of WML. Meanwhile, both increased age and decreased VitB12 level contribute to the elevated severity of WML.