代谢综合征对皮质下缺血性脑血管病影像学损害的影响

Effect of metabolic syndrome on the imagings of brain damage in patients with subcortical ischemic vascular disease

目的 探讨代谢综合征及其各因子对皮质下缺血性脑血管病（SIVD）影像学损害的影响. 方法 选取120例SIVD患者（SIVD组）,年龄其中包括非代谢综合征患者25例,代谢综合征倾向患者25例,代谢综合征患者70例.代谢综合征的诊断标准采用美国国家胆固醇教育计划成人治疗专家组Ⅲ（NCEP-ATPⅢ）标准.SIVD影像学损害采用改良Scheltens量表对头颅MRI进行评价,分为脑室旁、脑白质、基底节三个脑区评定并计算总分. 结果 代谢综合征倾向组脑室旁、脑白质、基底节评分、Scheltens总分[（3.75±1.60）分、（10.67±5.26）分、（3.21±2.62）分、（17.62±8.32）分]和代谢综合征组[（4.21±1.09）分、（13.79±5.25）分、（6.90±4.25）分、（24.90±9.25）分]均显著高于非代谢综合征组[（2.76±1.62）分、（6.36±3.93）分、（1.52±1.50）分、（10.58±5.89）分,均P＜0.05].腰围与脑白质得分及Scheltens总分呈显著正相关（r=0.185,P=0.046; r=0.488,P＜0.001）;三酰甘油（TG）与脑白质、基底节得分有显著正相关（r=0.188,P=0.042; r=0.311,P=0.001）;空腹血糖与脑白质、基底节得分以及Scheltens总分呈显著正相关（r=0.235,P=0.011; r=0.229,P=0.013; r=0.206,P=0.027）;高密度脂蛋白胆同醇（HDLC）与脑白质、基底节以及Schehens总分呈显著负相关（r=-0.238,P=0.010; r=-0.189,P=0.042;r=-0.335,P＜0.001）.进一步多元线性逐步回归分析结果发现空腹血糖、HDLC与脑白质评分显著相关（P均＜0.05）;TG与基底节评分显著相关（P＜0.05）;腰围、空腹血糖、HDL-C与Scheltens总分显著相关（P均＜0.05）. 结论 代谢综合征及其各因子与SIVD影像学损害相关,其中腹型肥胖、TG、空腹血糖、HDL-C是SIVD的重要危险因素.

Objective To investigate the effect of metabolic syndrome and its components on imaging of brain impairment in subcortical ischemic vascular disease.Methods 120 patients with subcortical ischemic vascular disease （SIVD） including 25 cases without metabolic syndrome,25 cases with the risk of metabolic syndrome,70 cases with metabolic syndrome.The diagnostic criteria of metabolic syndrome was the National Cholesterol Education Program Adult Treatment Panel Ⅲ （NCEP-ATP Ⅲ）.Brain MRI was assessed by the Scheltens scale,and divided into 3 regions：periventricular hyper intensities （PVH）,leukoaraiosis （LA）,basal ganglia hyper-intensities （BG）.Results The assessment scores of PVH,LA,BG and Scheltens scores were higher in patients with the risk of metabolic syndrome and patient with metabolic syndrome than in patient without metabolic syndrome [（3.75±1.60）,（4.21±1.09） us.（2.76±1.62）,（10.67±5.26）,（13.79±5.25） us.（6.36±3.93）,（3.21±2.62）,（6.90±4.25） us.（1.52±1.50）,（17.62±8.32）,（24.90±9.25）vs.（10.58± 5.89）,respectively,all P＜0.05].Waist circumference had positive correlations with LA and Scheltens scores （r=0.185,P=0.046; r=0.488,P＜0.001）.Positive correlation was found between triglyceride （TG） and LA,BG scores （r=0.188,P=0.042; r=0.311,P =0.001）.The positive correlations of impaired glucose tolerance （IGT） with LA,BG and Scheltens scores were found （r=0.235,P=0.011; r=0.229,P=0.013; r=0.206,P=0.027）.High density lipoproteincholesterol （HDL-C） was correlated negatively with LA,BG and Scheltens scores （r=-0.238,P=0.010;r=-0.189,P=0.042; r=-0.335,P＜0.001）.The further multivariate linear regression analysis showed that IGT,HDL-C had significant correlations with LA assessment score （both P＜0.05）,TG had significant correlation with BG assessment score （P＜0.05）,and waist circumfernce,IGT,HDL-C had significant correlations with Scheltens scores （all P＜ 0.05）.Conclusions Metabolic syndrome and its components correlate with the imagings of cerebral damage in SIVD.Abdominal obesity,TG,IGT,HDL-C are the important risk factors for SIVD.