非痴呆老年人脑白质高信号进展的危险因素分析

Analysis of risk factors for the progression of white matter hyperintensities in the non-demented elderly

目的探讨非痴呆老年人脑白质高信号(WMHs)进展的危险因素。方法从阿尔茨海默病神经影像学倡议(ADNI)-1队列中筛选完成基线及3年随访T2 FLAIR扫描的非痴呆老年人263例,根据WMHs是否进展分为进展组(n=66)与非进展组(n=197)。比较两组基线人口学资料、心血管疾病史、载脂蛋白E(apoE)基因型、认知功能、基线WMHs体积及3年随访时的WMHs体积,采用logistic回归分析非痴呆老年人WMHs进展的危险因素。结果WMHs进展组年龄、冠心病史比例、基线WMHs体积及3年随访时的WMHs体积高于非进展组,听觉词语学习测验即刻记忆评分、连线测验-B评分明显低于非进展组,差异有统计学意义(P<0.05)。年龄与基线WMHs体积及3年随访时的WMHs体积均呈正相关(rs=0.273,P<0.001;rs=0.306,P<0.001)。多因素logistic回归分析显示,年龄≥80岁和冠心病史是WMHs进展的独立危险因素(OR=2.257,95%CI 1.219~4.178,P=0.010;OR=2.556,95%CI 1.048~6.234,P=0.039)。结论非痴呆老年人WMHs进展的独立危险因素包括年龄≥80岁和冠心病史。

Objective To analysis the risk factors for the progression of white matter hyperintensities(WMHs)in the non-demented elderly.Methods A total of 263 non-demented elderly who completed baseline and 3-year follow-up T2 FLAIR scans were screened from the Alzheimer’s Disease Neuroimaging Initiative(ADNI)-1 cohort.They were divided into the progressive group(n=66)and non-progressive group(n=197)according to the progression of WMHs.The baseline demographic data,cardiovascular disease history,apolipoprotein E(apoE)genotype,cognitive function and WMHs volumes at baseline and three-year follow-up were compared between the two groups.The risk factors for the progression of WMHs in the non-demented elderly were evaluated by logistic regression analysis.Results The age,the proportion of coronary heart disease,the WMHs volume at baseline and three-year follow-up in WMHs progressive group were higher than those in non-progressive group,and the scores of immediate memory of auditory verbal learning test and trail making test-B were significantly lower than those in non-progressive group,and the differences were statistically significant(P<0.05).Age correlated positively with baseline WMHs volume and WMHs volume at three-year follow-up(rs=0.273,P<0.001;rs=0.306,P<0.001).Multivariate logistic regression analysis showed that age≥80 years and a history of coronary heart disease were independent risk factors for the progression of WMHs(OR=2.257,95%CI 1.219-4.178,P=0.010;OR=2.556,95%CI 1.048-6.234,P=0.039).Conclusion Age≥80 years and a history of coronary heart disease are independent risk factors for the progression of WMHs in the non-demented elderly.