小而密低密度脂蛋白胆固醇与老年人脑白质病变的相关性

Association between small dense low-density lipoprotein cholesterin and white matter lesions in the elderly

目的探讨小而密低密度脂蛋白胆固醇(sdLDL-C)与老年人脑白质病变的相关性。方法选择2012年5月~2015年7月济南地区年龄≥60岁的老年人409例,检测sdLDL-C水平,根据sdLDL-C三分位数分为一分位组136例(0.08~0.68 mmol/L),二分位组139例(0.69~1.07 mmol/L)和三份位组134例(1.08~3.10 mmol/L)。入选者头颅MRI扫描,评估总、室周和皮质下脑白质高信号(WMH)体积,并进行Fazekas可视化评分。采用Spearman秩相关分析,采用多因素线性回归和多因素logistic回归分析。结果与一分位组比较,二分位组和三分位组总、室周和皮质下WMH体积及Fazekas评分≥2分的患病率明显升高(P=0.000);且三分位组升高更明显(P=0.000)。sdLDL-C与总、室周和皮质下WMH体积呈正相关(r=0.582;r=0.369;r=0.603,P=0.000)。校正混杂因素后,sdLDL-C仍与总、室周和皮质下WMH体积呈显著正相关(P=0.000)。二分位组和三分位组总Fazekas评分≥2分发生的危险分别是一分位组的4.442倍和14.895倍;室周Fazekas评分≥2分发生的危险分别是3.829倍和7.367倍,皮质下Fazekas评分≥2分发生的危险分别是2.815倍和4.335倍。三分位组总、室周Fazekas评分≥2分发生的危险分别是二分位组的3.403倍(95%CI:1.637~7.071)和1.886倍(95%CI:1.117~3.186)。结论sdLDL-C水平升高是老年人脑白质病变的独立危险因素。

Objective To study the association between small dense low-density lipoprotein cholesterin(sdLDL-C)and WML in the elderly.Methods Four hundred and nine≥60 years old subjects recruited from Jinan area from May 2012 to July 2015 were divided into first tertile group(n=136),second tertile group(n=139)and third tertile group(n=134)according to their serum sdLDL-C level.The patients underwent skull MRI.The volumes of total,periventricular,subcortical WMH were assessed and scored according to the Fazekas scale,and analyzed by Spearman correlation analysis,multivariate linear regression analysis and multivariate logistic regression analysis respectively.Results The volumes of total,periventricular and subcortical WMH were significantly larger,and the incidence of WML with their Fazekas scale score≥2 was significantly higher in second and third tertile groups than in first tertile group(P=0.000)and in third tertile group than in first and secend tertile groups(P=0.000).The serum sdLDL-C level was positively related with the volumes of total,periventricular and subcortical WMH(r=0.582,r=0.369,r=0.603,P=0.000)and even after adjustment for confounders(P=0.000).The risk of total,periventricular and subcortical WMH with their Fazekas scale score≥2 was 4.442-fold and 14.895-fold higher,3.829-fold and 7.367-fold higher,2.815-fold and 4.335-fold higher respectively in second and third tertile groups than in first tertile group.The risk of total and periventricular WMH with their Fazekas scale score≥2 was 3.403-fold and 1.886-fold higher respectively in third terile group than in second tertile group(95%CI:1.637-7.071,95%CI:1.117-3.186).Conclusion Serum sdLDL-C level is an independent risk factor for brain WML in the elderly.