脑微出血与脑小血管病患者步态障碍关系的研究

The relationship between cerebral microbleeds and gait disorder in patients with cerebral small vessel disease

目的探讨脑小血管病(CSVD)患者步态障碍的特点及脑微出血病灶的数目、部位与步态障碍的相关性。方法选择102例CSVD患者,根据合并脑微出血情况分为CSVD伴脑微出血组(n=29)和CSVD不伴脑微出血组(n=73)。另选择年龄、性别等相匹配的头颅MRI检查无CSVD的健康体检者作为对照组(n=30)。对所有受试者进行定量步态参数测定,比较脑小血管病组和正常对照组之间步态参数的差异性。测定的步态参数包括步长、步速、步频、双脚支撑相百分比等,统计分析比较CSVD患者脑微出血病灶数目及部位与步长、步速、步频、双脚支撑相百分比等步态参数的相关性。结果CSVD伴脑微出血组较正常组步长缩短、步速减慢,差异有统计学意义(P<0.05)。CSVD不伴脑微出血组较正常组步长缩短、步频增快,差异有统计学意义(P<0.05)。CSVD伴脑微出血组与CSVD不伴脑微出血组比较,差异均无统计学意义。脑微出血病灶数目与步长呈负相关(r=-0.295,P=0.001),与双脚支撑相呈正相关(r=0.225,P=0.011),即脑微出血病灶数目越多、步长更短、双脚支撑相更长。额叶、颞叶和深部的脑微出血与步长变短、步速减慢相关(P<0.05)。结论脑微出血作为独立因素和CSVD患者的步态障碍有相关性。额叶、颞叶和深部脑微出血病灶与步态障碍存在相关性。

Objective To investigate the characteristics of gait disorders in patients with cerebral small vessel disease(CSVD)and the correlation between the number and location of cerebral microbleeds and gait disorders.Methods 102 patients with cerebral small vessel disease were enrolled and divided into CSVD with cerebral microbleeds group(n=29)and CSVD without cerebral microbleeds group(n=73).In addition,age and sex-matched patients who without CSVD on cranial MRI were selected as the control group(n=30).The quantitative gait parameters of all subjects were measured,and the differences of gait parameters between cerebrovascular disease group and normal control group were compared.The gait parameters included step length,gait speed,stride frequency,and the percentage of bipedal support phase.The correlation between the number and location of cerebral microbleeds and gait parameters such as step length,gait speed,gait frequency and the percentage of bipedal support phase were statistically analyzed.Results Compared with the normal group,CSVD with cerebral microbleeds group was significantly shorter and slower(P<0.05)while CSVD without cerebral microbleeds group was shorter and faster(P<0.05).There was no significant difference between CSVD with cerebral microbleeds and CSVD without cerebral microbleeds.The number of cerebral microbleeds was negatively correlated with step length(r=-0.295,P=0.001)and positively correlated with foot support(r=0.225,P=0.011),the more the number of cerebral microbleeds,the shorter the step length and the longer the support phase of feet.The cerebral microbleeds in frontal lobe,temporal lobe and deep part were associated with shorter step length and slower walking speed(P<0.05).Conclusion As an independent factor,cerebral microbleeds are associated with gait disorders in patients with cerebrovascular diseases.Frontal lobe,temporal lobe and deep cerebral microbleeds are correlated with gait disorders.