可独立行走的脑小血管病患者跌倒风险相关危险因素分析

Analysis of risk factors associated with fall risk patients with cerebral small vessel disease who can walk independently

目的筛查可独立行走的脑小血管病患者存在较高跌倒风险的相关危险因素。方法纳入2017年12月至2020年12月天津市环湖医院收治的226例脑小血管病患者,采集临床资料(包括性别、年龄、身高、体重、既往史、静息状态血压、空腹血糖和糖化血红蛋白),头部MRI观察腔隙性梗死和脑白质高信号(包括脑深部白质高信号和脑室旁白质高信号),颈动脉超声测量内-中膜厚度,睁眼时单腿站立测验(OLST)评估姿势稳定性。单因素和多因素前进法Logistic回归分析筛查可独立行走的脑小血管病患者存在较高跌倒风险的相关危险因素。结果根据OLST测验时间,分为高跌倒风险组(≤10 s,104例)和低跌倒风险组(>10 s,122例)。Logistic回归分析显示,高龄(OR=1.053,95%CI:1.006~1.101;P=0.026)、既往有糖尿病(OR=2.910,95%CI:1.288~6.577;P=0.010),以及脑深部白质高信号Fazekas评分为1(OR=7.329,95%CI:1.775~30.272;P=0.006)、2(OR=8.004,95%CI:1.905~33.627;P=0.005)和3(OR=23.884,95%CI:4.205~135.657;P=0.000)是可独立行走的脑小血管病患者存在较高跌倒风险的危险因素。结论看似步态正常、可独立行走的脑小血管病患者仍存在较高的跌倒风险,高龄、糖尿病史和脑深部白质高信号是其危险因素。

Objective To explore the risk factors related to higher fall risk in patients with cerebral small vessel disease(CSVD)who can walk independently.Methods A total of 226 patients with CSVD treated in Department of Neurorehabilitation,Tianjin Huanhu Hospital from December 2017 to December 2020 were included.Clinical data(including sex,age,height,weight,past medical history,resting blood pressure,fasting blood glucose and glycosylated hemoglobin)were collected.Lacunar infarct(LACI)and white matter hyperintense[deep white matter hyperintense(DWMH)and periventricular white matter hyperintense(PWMH)]were observed by MRI,carotid intima-media thickness(IMT)was measured by color Doppler ultrasound.Postural instability was assessed based on One-Leg Standing Test(OLST).Univariate and multivariate forward Logistic regression analysis were used to screen the risk factors of higher fall risk in patients with CSVD who can walk independently.Results According to OLST time,the patients were divided into high fall risk group(≤10 s,104 cases)and low fall risk group(>10 s,122 cases).Univariate and multivariate forward Logistic regression analysis suggested that age(OR=1.053,95%CI:1.006-1.101;P=0.026),diabetes history(OR=2.910,95%CI:1.288-6.577;P=0.010),DWMH Fazekas score 1(OR=7.329,95%CI:1.775-30.272;P=0.006),Fazekas score 2(OR=8.004,95%CI:1.905-33.627;P=0.005)and Fazekas score 3(OR=23.884,95%CI:4.205-135.657;P=0.000)were the risk factors of higher fall risk patients with CSVD who can walk independently.Conclusions For patients with CSVD,especially those who appear to have a normal gait and can walk independently,there is still a high risk of falling,which may be independently related to the age,diabetes history and DWMH.