老年人心脏瓣膜钙化和脑白质损害的关系研究

Relationship between heart valves calcification and brain white matter injury in elderly patients

目的观察老年人心脏瓣膜钙化与磁共振定义的脑白质损害的关系。方法纳入120例老年人,均行头颅核磁共振和心脏二维超声检查,记录病史并完善其他实验室检查。采用Fazekas量表将患者分为病理性白质损伤组和非病理性白质损伤组,比较2组老年人的临床特征、主动脉瓣钙化率、二尖瓣钙化率、肾小球滤过率、血脂水平、心功能等情况。结果病理性白质损伤组年龄、主动脉瓣钙化率,任意瓣膜的钙化率均明显高于非病理性白质损伤组(P均<0.01),而其肾小球滤过率(e GFR)则明显低于非病理性白质损伤组(P<0.01)。2组的左心室射血分数(LVEF)差异无统计学意义(P=0.219)。Logistic回归显示,校准年龄、性别、高血压、糖尿病、吸烟、胆固醇、心功能、糖化血红蛋白(Hb A1c)、促甲状腺素及e GFR因素后,主动脉瓣钙化仍是老年人病理性白质损伤的独立危险因素(OR=5.62,P<0.05),而任意瓣膜的钙化及二尖瓣钙化与老年人病理性白质损伤无关(P>0.05)。结论老年人主动脉瓣钙化与病理性脑白质损害有关。

Objective To study the association of heart valves calcification with brain white matter injury defined by magnetic resonance imaging（ MRI） in elderly patients. Methods A total of 120 participants without clinical histories of stroke or transient ischemic attack undergoing brain MRI and echocardiographic exams were enrolled. According to MRI and Fazekas rating scale,all participants were classified into pathologic white matter injury group and non-pathologic white matter injury group. Clinical characteristics,estimated glomerular filltration rate（ e GFR）,blood lipid level,left venricular eject fraction（ LVEF） and cardiac valvular calcifications were compared between two groups. Results Compared with non-pathologic white matter injury group,the age and the incidence of aortic valvular calcification and any cardiac valvular calcification were significantly higher in pathologic white matter injury group（ all P〈0. 01）. However,there was no significant difference between two groups in LVEF. The level of e GFR was significantly lower in pathologic white matter injury group than that in non-pathologic white matter injury group（ P〈0. 01）. Logistic regression analysis showed that adjusted for age,gender,hypertension,diabetes,smoking,low density lipoprotein cholesterol,Lipoprotein-a,Hb A1 c,thyroid-stimulaing hormone,LVEF and e GFR showed that aortic valvular calcification was associated with pathologic white matter injury（ OR = 5. 62,P〈0. 05）. However,neither any valvular calcification nor mitral valvular calcification was associated with pathologic white matter injury. Conclusions Aortic valvular calcification is associated with pathologic brain white matter injury.