脑小血管病患者核磁总负荷与同型半胱氨酸的相关性

Correlation of total magnetic resonance imaging burden with homocysteine in patients with cerebral small vessel disease

目的探讨脑小血管病(cerebral small vessel disease,CSVD)患者核磁总负荷与血清同型半胱氨酸(Hcy)的相关性,为疾病防治提供线索。方法选择2016年9月至2018年12月在医院神经内科住院的CSVD患者370例,收集血清Hcy水平在内的临床资料。采集头颅磁共振(MRI)数据,包括脑白质高信号(white matter hyperintensities,WMH)、腔隙性脑梗死(lacune infarcts,LI)、脑微出血(cerebral microbleeds,CMBs)及扩大的血管周围间隙(enlarged perivascular spaces,ePVS)评估CSVD总负荷,采用SPSS 21.0统计分析CSVD总负荷与Hcy的相关性。结果(1)与低水平Hcy患者相比,高Hcy患者CSVD核磁总负荷更重(P<0.01)。(2)进一步根据CSVD核磁总负荷评分情况将研究对象分为低负荷组(n=106)和中高负荷组(n=64),单因素及多因素逐步Logistic回归分析证实血清Hcy水平(OR=1.026;95%CI:1.003~1.049;P=0.026)是CSVD核磁总负荷增加的独立危险因素,高同型半胱氨酸血症是CSVD核磁总负荷增加的强预测因子(OR=3.202,95%CI:1.947~5.268;P<0.001)。结论血清Hcy是CSVD核磁总负荷的独立危险因素,为CSVD疾病预测及临床管理提供了重要线索。

Objective To explore the relationship between total MRI burden and serum homocysteine(Hcy)in patients with cerebral small vessel disease(CSVD),and to provide clues for disease prevention and treatment.Methods A total of 370 inpatients with CSVD from the neurology department of hospital were consecutively enrolled from September 2016 to December 2018.The clinical data,including serum homocysteine(Hcy)levels were collected.Brain MRI data were collected,including the severity of white matter hyperintensities(WMH),lacune infarcts(LI),cerebral microbleeds(CMBs),and enlarged perivascular spaces(ePVS)to evaluate the total load of CSVD.SPSS21.0 was applied to analyze the association between total CSVD burden and Hcy.Results(1)Compared with the patients with lower Hcy levels,the higher Hcy group had heavier total burdens of CSVD(P<0.01).(2)According to the total MRI burden scores of CSVD,all patients were further divided into low burden group(106 cases)and moderate-high burden group(264 cases).Multivariate logistic regression analysis showed that Hcy(OR=1.026,95%CI:1.003-1.049,P=0.026)was risk factor for increasing CSVD burden and hyperhomocysteinemia was a stronger predictor for total MRI burdens of CSVD(OR=3.202,95%CI:1.947-5.268,P<0.001).Conclusion Serum Hcy can be an independent risk factor for the total MRI burdens of CSVD.This finding provides a promising clue for the prediction and clinical management of CSVD.