血清胱抑素C与脑白质病变的相关性研究

Association of cystatin C level with cerebral white matter lesions: clinical report of 473 cases

目的探讨血清胱抑素C（Cystatin C，CysC）水平和脑白质病变（white matter lesions, WMLs）的相关性。方法收集2014年7月至2015年3月本科住院患者资料，胶体金免疫增强法检测血清CysC水平，颅脑MRI检查评估脑白质病变，采用Fazekas标准分别对患者脑室旁脑白质病变（P-WMLs）和深部脑白质病变（D-WMLs）的严重程度进行评价，危险因素的分析采用有序多分类Logistic回归分析。结果共473例患者纳入研究，男性190例，年龄（65.7±9.1）岁。重度（0.82±0.18）和中度P-WMLs患者（0.78±0.15）血清CysC水平均高于轻度P-WMLs患者（0.73±0.14），重度（0.82±0.18）和中度D-WMLs患者（0.79±0.16）血清CysC水平同样高于轻度D-WMLs患者（0.74±0.14），差异均有统计学意义（P〈0.05），二者均提示随着WMLs病变程度的增加CysC水平也越高。多因素有序多分类Logistic回归分析结果显示，高水平的CysC（P-WMLs：OR=8.21，95%CI=2.18~30.88；D-WMLs：OR=7.01，95%CI=1.69~29.11）、年龄（P-WMLs：OR=5.18，95%CI=2.81~9.55；D-WMLs：OR=4.32，95%CI=2.05~9.08）和高血压（P-WMLs：OR=3.46，95%CI=2.30~5.21；D-WMLs： OR=3.52，95%CI=2.21~5.62）均为WMLs严重程度增加的危险因素。结论血清CysC水平与WMLs病变程度呈正相关；高水平CysC、高龄及高血压是WMLs病变严重程度增加的危险因素。

Objective To determine the relationship between serum level of Cystatin C （CysC） and cerebral white matter lesions （WMLs）. Methods The 50-year-old and older patients admitted in our department from July 2014 to March 2015 were prospectively recruited in this study. Colloidal gold immunoassay was used to determine their serum CysC level. MRI scanning was employed to identify WMLs, and Fazekas scale was used to grade the patients into periventricular WMLs （P-WMLs） and deep WMLs （D-WMLs） groups. Multivariate logistic regression analyses were performed to examine the association of CysC with WMLs. Results There were 190 males and 283 males, at a mean age of 65.7±9.1 in the cohort. In P-WMLs group, the CysC level was significantly higher in the severe and moderate groups than the mild group （0.82±0.18 and 0.78±0.15 vs 0.73±0.14 mg/L, P〈0.05）. And in D-WMLs group, the level was also obviously higher in severe and moderate groups than the mild group （0.82±0.18 and 0.79±0.16 vs 0.74±0.14, P〈0.05）. The results indicated that the severer MMLs was, the higher the CysC level was. Multivariate logistic regression analyses showed that CysC level （P-WMLs： OR=8.21, 95%CI：2.18~30.88; D-WMLs： OR=7.01, 95%CI： 1.69~29.11）, age （P-WMLs： OR=5.18, 95%CI： 2.81~9.55; D-WMLs： OR=4.32, 95%CI： 2.05~9.08） and hypertension （P-WMLs： OR=3.46, 95%CI： 2.30~5.21; D-WMLs： OR=3.52, 95%CI： 2.21~5.62） were risk factors for the increased severity of WMLs. Conclusion CysC level is positively correlated with the severity of WMLs. Elevated CysC level, older age and hypertension are independent risk factors for increased severity of WMLs.