不同位置中重度脑白质疏松的危险因素研究

Risk Factors of Moderate or Severe Leukoaraiosis in Different Lesion Locations

目的探讨不同位置中重度脑白质疏松(LA)的危险因素,以提高对该病的认识。方法选择2012年4月—2014年3月在洪泽县人民医院神经内科诊断的短暂性脑缺血发作(TIA)或脑梗死患者195例。回顾性性分析患者的临床资料、颅脑MRI检查结果,采用Fazekas评分法分别对侧脑室旁LA和半卵圆中心LA进行严重程度分级,采用多因素Logistic回归分析筛选不同部位中重度LA的危险因素。结果侧脑室旁无或轻度LA患者78例,侧脑室旁中重度LA患者117例,不同严重程度侧脑室旁LA患者年龄、高血压发生率、卒中史阳性率、颅外血管狭窄率及尿素、肌酐水平比较,差异有统计学意义(P<0.05);半卵圆中心无或轻度LA患者43例,半卵圆中心中重度LA患者152例,不同严重程度半卵圆中心LA患者年龄、高血压发生率、卒中史阳性率、颅外血管狭窄率及尿素水平比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,高龄、高血压、颅外血管狭窄是侧脑室旁中重度LA的危险因素(P<0.05);而高龄、高血压、有卒中史是半卵圆中心中重度LA的危险因素(P<0.05)。结论中重度侧脑室旁LA和半卵圆中心LA具有不同的危险因素,高龄、高血压是LA最主要的危险因素,而颅外血管狭窄主要影响侧脑室旁LA。

Objective To investigate the risk factors of moderate or severe leukoaraiosis in different lesion locations,to improve the awareness of clinicians.Methods A total of 195 patients with transient ischemic attack or cerebral infarction were selected in the People＇s Hospital of Hongze County from April 2012 to March 2014,and their clinical data and brain MRI findings were retrospectively analyzed,Fazekas score was used to judge the severity of periventricular leukoaraiosis and centrumsemioval leukoaraiosis,multivariate Logistic regression analysis was used to analyze the risk factors of moderate or severe leukoaraiosis in different lesion locations.Results Out of the 195 patients,78 cases occurred mild periventricular leukoaraiosis or were without periventricular leukoaraiosis（served as A group）,117 cases occurred moderate or severe periventricular leukoaraiosis（served as B group）;43 cases occurred mild centrumsemioval leukoaraiosis or were without centrumsemioval leukoaraiosis（served as C group）,152 cases occurred moderate or severe centrumsemioval leukoaraiosis（served as D group）.There were statistically significant differences of age,incidence of hypertension,positive rate of stroke history,extracranial vascular stenosis rate,urea nitrogen and creatinine between groups A and B（P〈0.05）;and so were age,incidence of hypertension,positive rate of stroke history,extracranial vascular stenosis rate and urea nitrogen between groups C and D（P〈0.05）.Multivariate Logistic regression analysis showed that,advanced age,hypertension,extracranial vascular stenosis were risk factors of moderate or severe periventricular leukoaraiosis（P〈0.05）,while advanced age,hypertension,positive stroke history were risk factors of moderate or severe centrumsemioval leukoaraiosis（P〈0.05）.Conclusion The risk factors of moderate or severe periventricular leukoaraiosis and centrumsemioval leukoaraiosis are different,advanced age,hypertension are the main risk factors of leukoaraiosis,while extracranial vascular stenosis mainly affects periventricular leukoaraiosis.