社区人群排尿障碍与脑小血管病影像改变的相关性研究

Correlation between urinary disorders and imaging changes of cerebral small vessel diseases in community-dwelling populations

目的探讨社区人群中,排尿障碍与脑小血管病影像改变的相关性。方法采用横断面研究方法,于2013年6月-2016年4月在北京市顺义社区人群队列中筛选年龄≥35岁,无脑卒中史,无泌尿系统疾病史,完成头颅MRI检查且序列完整、图像清晰的居民。采集参与者的一般人口学信息、血管病危险因素、认知功能、排尿障碍参数(任何形式的排尿障碍、尿失禁、白天排尿频度、夜尿频度)及影像参数(脑小血管病影像标志物如脑白质高信号、腔隙、脑微出血、血管周围间隙、脑体积)。使用logistic回归模型评估排尿障碍与脑小血管病影像改变的相关关系。结果符合入组标准及基线信息、排尿障碍参数齐全的参与者共916例,平均年龄为57.4岁,男性占36.2%。多因素模型中,脑小血管病影像改变包括脑白质病变程度、腔隙、脑微出血、血管周围间隙及脑体积分数与任何形式的排尿障碍不相关(P>0.05);脑小血管病影像改变与尿失禁不相关(P>0.05);排尿频率方面,脑小血管病影像改变与夜尿频度不相关(P>0.05),而低脑体积与白天排尿频度相关[3~5次/d与<3次/d相比:比值比(odds ratio,OR)=2.520,95%置信区间(confidence interval,CI)(1.278,4.972),P=0.008;>5次/d与<3次/d相比:OR=3.115,95%CI(1.317,7.372),P=0.010]。结论社区人群中,脑萎缩相关的脑结构改变可能对白天排尿频度造成影响。脑白质病变程度、腔隙、微出血、血管周围间隙与任何形式的排尿障碍不相关。

Objective To explore the correlation between urinary disorders and imaging changes of cerebral small vessel diseases(CSVDs)in community-dwelling populations.Methods A cross-sectional analysis was conducted on participants enrolled in the Shunyi study from June 2013 to April 2016.Eligible participants were community-dwelling populations aged≥35 years with interpretable magnetic resonance imaging scans and no history of stroke or urinary system diseases.Data on demographic characteristics,vascular risk factors,cognitive functions,and urinary disorders(including any form of urinary disorders,incontinence,daytime urination frequency,and nocturnal urination frequency)were collected.Imaging changes including white matter hyperintensities(WMHs),lacunes,cerebral microbleeds(CMBs),perivascular spaces(PVSs),and brain volume were measured using 3 T magnetic resonance imaging.Logistic regression model analysis was performed to identify the potential correlations between urinary disorders and imaging markers of CSVD.Results A total of 916 participants(with a mean age of 57.4 years;36.2%were males)were finally enrolled in this study based on the enrollment criteria.CSVD imaging changes of WMHs,lacunes,CMBs,PVSs or brain volume were not associated with any form of urinary disorders in multivariable models(P>0.05).CSVD imaging changes were not associated with presence of urinary incontinence(P>0.05).In terms of urinary frequency,the CSVD imaging changes were not related to nocturnal urinary frequency(P>0.05).However,lower brain volume was correlated with daytime urination frequency[3-5 vs.<3 times per day:odds ratio(OR)=2.520,95%confidence interval(CI)(1.278,4.972),P=0.008;>5 vs.<3 times per day:OR=3.115,95%CI(1.317,7.372),P=0.010].Conclusion Brain atrophy may affect daytime urination frequency in community-dwelling populations.