合并高血压脑白质病变相关影响因素分析

Analysis of related factors of white matter lesions in hypertension

目的探讨尿酸、肌酐、β2微球蛋白、同型半胱氨酸(Hcy)、H型高血压与合并高血压脑白质病(white matter lesions,WML)的关系。方法回顾性研究2015-09—2017-06作者医院就诊的合并高血压WML患者384例,收集患者头颅MRI、头颅磁共振弥散成像(diffusion weighted imaging,DWI)影像学资料以及血Hcy、尿酸、肌酐、β2微球蛋白水平资料。根据Hcy水平将患者分为H型高血压组(Hcy≥10μmol/L)和单纯高血压组(Hcy<10μmol/L),根据WML严重程度分为无病变、轻度、中度、重度亚组。比较各组间尿酸、肌酐、β2微球蛋白水平的差异,并采用有序多因素Logistic回归分析影响WML严重程度的因素。结果 H型高血压组患者肌酐、尿酸水平高于单纯高血压组(均P<0.01)。单纯高血压组重度WML组患者肌酐水平高于无病变组和轻度WML组,轻、中、重度WML组患者尿酸水平高于无病变组(P<0.05)。H型高血压组中、重度WML组患者肌酐水平高于无病变组和轻度WML组(P<0.05),轻、中、重度WML组患者尿酸水平高于无病变组(P<0.05)。多因素有序Logistic逐步回归结果显示,H型高血压、Hcy、肌酐和尿酸是影响WML严重程度的独立危险因素(P<0.05)。结论 H型高血压、Hcy、肌酐和尿酸是影响WML严重程度的独立危险因素。

Objective To investigate the relationship between uric acid,creatinine,β2 microglobulin,homocysteine(Hcy),H type hypertension and white matter lesions(WML)in hypertension.Methods The clinical characteristics of 384 hypertension with WML who were admitted to the Affiliated Hospital of Chengde Medical College from September 2015 to June 2017 were analyzed retrospectively.We collected the patients clinical data,which were imaging information such as MRI,diffusion weighted imaging(DWI),and levels of Hcy,uric acid,creatinine,andβ2 microglobulin.The patients were divided into H type hypertension group and simple hypertension group,according to Hcy concentration.The H type hypertenson group included patients with homocysteine>10μmol/L and the simple hypertension group included patients with homocysteine<10μmol/L.The patients were divided into four subgroups based on the severity of WML,including the no,the mild,the moderate,and the severe groups.The differences of uric acid,creatinine andβ2 microglobulin in each group were compared.Ordinal multivariate logistic regression analysis was used to analyze the factors affecting the severity of WML.Results The serum uric acid and creatinine levels of the patients in the H type hypertension group were significantly higher than the simple hypertension group(P<0.05).In the simple hypertension group,the creatinine level in the severe WML group was higher than that in the no group and the mild WML group(P<0.05),the levels of uric acid in patients with mild,moderate and severe WML were significantly higher than those without WML(P<0.05).In the H type hypertension group,the levels of creatinine in moderate and severe WML patients were higher than those in no and mild WML patients(P<0.05),the levels of uric acid in patients with mild,moderate and severe WML were significantly higher than those without WML(P<0.05).Ordinal multivariate logistic regression analysis showed that H type hypertension,Hcy,creatinine,and uric acid were independent risk factors affecting the severity of WML(P<0.05).Conclusions H type hypertension,Hcy,creatinine,and uric acid are independent risk factors affecting the severity of WML.