老年脑白质疏松症患者衰弱状况与脑白质高信号的相关性

Correlation between frailty status and white matter hyperintensity in elderly patients with leukoaraiosis

目的:了解老年脑白质疏松症(leukoaraiosis,LA)患者的衰弱状况并分析脑白质高信号与其衰弱状况的相关性。方法:2019年6月至2020年9月通过头颅MRI筛选65岁以上脑白质疏松症患者162例。采用Fried衰弱表型评估其衰弱状况,采用Fazekas量表评分法对头颅MRI影像进行脑室周围白质高信号(periventricular white matter hyperintense,PVH)和深部白质高信号(deep white matter hyperintense,DWMH)独立评分。采用SPSS 22.0软件进行统计学处理分析。正态分布数据组间比较采用ANOVA检验,非正态分布数据组间比较采用Kruskal-Wallis H检验。PVH及DWMH评分与Fried衰弱表型评分的相关性采用Spearman秩相关分析。结果:162例老年LA患者中不同衰弱表型分别为无衰弱46例(28.40%),衰弱前期76例(46.91%),衰弱40例(24.69%);不同衰弱状况的老年LA患者之间在年龄(F=9.382,P<0.01)、慢性病数(H=10.736,P<0.01)、服药数量(H=15.927,P<0.01)、微型营养评估简表(MNA-SF)评分(F=5.263,P<0.01)方面差异有统计学意义。不同衰弱状况的老年LA患者PVH评分差异有统计学意义(χ2=108.537,P<0.01),而DWMH评分差异无统计学意义(χ2=4.239,P>0.05);Spearman秩相关分析显示老年LA患者PVH评分与衰弱表型评分呈显著正相关(r=0.718,P<0.01)。结论:老年LA患者衰弱的发生率较高,可能与增龄、多病共存、多重用药、营养风险等因素有关。老年LA患者衰弱的发生与脑室周围白质病变相关,且白质损害越严重,衰弱程度越高。

Objective To investigate frailty status of the elderly patients with leukoaraiosis(LA)and to analyze the correlation between white matter hyperintensities and their frailty status.Methods From June 2019 to September 2020,a total of 162 patients with leukoaraiosis over 65 years old were screened by cranial MRI.The Fried frailty phenotype was used to evaluate their frailty status.The Fazekas scale scoring method was used to independently assess the periventricular white matter hyperintense(PVH)and deep white matter hyperintense(DWMH)by the cranial MRI images.SPSS 22.0 software was used for statistical analysis.ANOVA test was used to compare normal distribution data between groups,and Kruskal-Wallis H test was used to compare non-normal distribution data between groups.Spearman rank correlation analysis was used to analyze the correlation between PVH and DWMH scores and Fried frailty phenotype score.Results Among 162 elderly patients with leukoaraiosis,46 patients(28.40%)were non-frailty,76 patients(46.91%)were pre-frailty and 40 patients(24.69%)were frailty.There were statistically significant differences in age(F=9.382,P<0.01),number of chronic diseases(H=10.736,P<0.01),number of medication(H=15.927,P<0.01)and mini-nutritional assessment short form(MNA-SF)scores(F=5.263,P<0.01)among older LA patients with different frailty phenotype.There was statistical difference in PVH scores in elderly LA patients with different frailty phenotype(χ2=108.537,P<0.01),but no significant difference in DWMH scores(χ2=4.239,P>0.05).Spearman correlation analysis showed significant positive correlation between PVH score and frailty phenotype score in elderly LA patients(r=0.718,P<0.001).Conclusion Elderly LA patients have a high incidence of frailty,which may be related to aging,multi-disease coexistence,multiple medication,nutritional risk and other factors.The occurrence of weakness in elderly LA patients is related to periventricular white matter lesions,and the more serious the white matter damage,the more obvious the degree of frailty.