血尿酸水平与急性脑梗死脑白质病变的相关性研究

Relationship between serum uric acid and white matter lesions in cerebral ischemic stroke patients

目的探讨急性脑梗死病人血尿酸水平与脑白质病变(WMLs)程度及部位的关系。方法连续入选2016年6月至2018年6月蚌埠市第三人民医院神经内科收治的急性脑梗死病人进行横断面回顾性研究,按照Fazekas量表评分将病人分成四组:重度WMLs组,中度WMLs组,轻度WMLs组和无WMLs组。比较各组病人性别、年龄、既往史及血尿酸及其他血生化相关指标,并进行logistic回归分析WMLs及不同程度WMLs危险因素。分析不同部位脑白质病变与血尿酸水平的相关性。结果共入选急性脑梗死病人659例,其中重度WMLs 60例,中度145例,轻度425例,无WMLs 29例,对四组进行基线分析,年龄(χ2=16.84,P=0.000)、既往脑梗死病史(χ2=28.06,P=0.000)、冠心病(χ2=20.119,P=0.000)、TC水平(F=3.00,P=0.030)、HDL⁃C水平(F=3.01,P=0.032)及尿酸水平(F=4.672,P=0.03)差异有统计学意义。多因素回归分析后,年龄及既往梗死是WMLs发生的显著影响因素。其中年龄[比值比(OR)1.042,95%置信区间(CI)1.005~1.080,P=0.027]是轻度WMLs的独立危险因素;年龄[比值比(OR)1.055,95%置信区间(CI)1.013~1.099,P=0.010]、既往脑梗死病史[比值比(OR)3.533,95%置信区间(CI)1.108~11.268,P=0.033]是中度WMLs的独立危险因素;年龄[比值比(OR)1.104,95%置信区间(CI)1.042~1.169,P=0.001]、既往脑梗死病史[比值比(OR)4.371,95%置信区间(CI)1.342~18.345,P=0.001]及高血尿酸水平[比值比(OR)1.004,95%置信区间(CI)1.001~1.007,P=0.009]是重度WMLs的独立危险因素。与无WMLs病人比较发现单纯脑室旁白质病变及深部脑白质病变病人的血尿酸水平差异无统计学意义,仅重度混合病变组血尿酸水平较无病变组明显升高,差异有统计学意义(P<0.05)。结论高龄及既往梗死病史与急性脑梗死病人并发脑白质病变呈正相关,高血尿酸水平是重度脑白质病变发生的独立危险因素。

Objective To investigate the relationship between serum uric acid and the severity,location of white matter lesions(WMLs)in acuteischemic stroke patients.Methods From June 2016 to June 2018,a cross⁃sectional study was conducted at the in⁃patient Department of Neurology in The Third People’s Hospital of Bengbu.The patients were divided into four groups according to the score of Fazekas scoring criteria:no WMLs,mild WMLs,moderate WMLs and severe WMLs.Serum biochemical indices suchas⁃serum uric acid,serum glucose,triglyceride(TG),total cholesterol(TC),low density lipoprotein⁃cholesterol(LDL⁃C)and high den⁃sity lipoprotein⁃cholesterol(HDL⁃C),age,past history were analyzed within the four groups.The risk factors for mild,moderate and severe WMLs were analyzed with multivariate logistic regression models.The UA tendency in different parts of WMLs were analyze.Results Six hundred and fifty⁃nine patients with acute cerebral ischemic stroke were enrolled into this study,29 of them in no WMLs group,425 in mild WMLs group,145 in moderate WMLs group and 60 in severe WMLs group.By analyzing all the baseline data,the differences of the age(χ2=16.84,P=0.000),the history of ischemic stroke(χ2=28.06,P=0.000),CAD(χ2=20.119,P=0.000),TC(F=3.00,P=0.030),HDL(F=3.01,P=0.032)and serum uric acid(F=4.672,P=0.03)were statistically significant in the 4 groups.After adjustment for several factors of WMLs,the age[odds ratio(OR)1.042,95%confidence interval(CI)1.005⁃1.080,P=0.027]were independent risk factors for mildWMLs,and the age[odds ratio(OR)1.055,95%confidence interval(CI)1.013⁃1.099,P=0.010],history of ischemic stroke[odds ratio(OR)3.533,95%confidence interval(CI)1.108⁃11.268,P=0.033]were independent risk factors for moderate WMLs and the age[odds ratio(OR)1.104,95%confidence interval(CI)1.042⁃1.169,P=0.001],history of ischemic stroke[odds ratio(OR)4.371,95%confidence interval(CI)1.342⁃18.345,P=0.001]serum uric ac⁃id[odds ratio(OR)1.004,95%confidence interval(CI)1.001⁃1.007,P=0.009]were independent risk factors for severe WMLs.The levels of serum uric acid in patients of pure periventricular WMLs and pure deep WMLs showed no statistically significance compared to the no WMLs group,while the level of serum uric acid of severe mixed WMLs group was significantly higher than no WMLs group.Conclusion These data suggest that the older age and the history of ischemic stroke are positively correlated with the formation of WMLs in the ischemic stroke patients,while serum uric acid is the independent risk factor for severe WMLs.