脑白质高信号与步态异常和平衡障碍的相关性研究

Correlation of white matter hyperintensity with gait abnormalities and balance disorders

目的探讨不同负担、不同部位的脑白质高信号(WMH)与步态异常和平衡障碍的相关性。方法纳入2021年6月—2022年6月于蚌埠医学院第一附属医院神经内科住院治疗的WMH患者84例,根据Fazekas量表评分分为低负担组45例、中负担组17例和高负担组22例,测量步长、步宽、步速和Tinetti平衡与步态量表综合评估步态与平衡功能,应用Pearson相关性分析研究不同负担不同部位WMH与步态异常和平衡障碍的相关性。结果WMH高负担组步长最短、步宽最长、步速最慢,Tinetti平衡与步态评分最低,组间比较差异有统计学意义(P<0.05)。Pearson相关性分析显示脑室周围白质高信号(PWMH)与步长、步速、Tinetti总分、Tinetti平衡与步态测试评分呈负相关关系(r=-0.787、-0.480、-0.670、-0.435、-0.600,均P<0.01),与步宽呈正相关关系(r=0.740,P<0.01);深部白质高信号(DWMH)与步速、Tinetti总分及Tinetti平衡评分呈负相关关系(r=-0.402、-0.698、-0.795,均P<0.05)。结论WMH与步态异常和平衡障碍存在相关性,随WMH负担增加,表现为步长缩短、步宽增加、步速减慢,步态和平衡功能损害,PWMH评分与步态异常相关性较高,DWMH评分与平衡障碍相关性较高。

Objective To assess the correlation of white matter hyperintensity(WMH)in different burdens and regions of the brain with gait abnormalities and balance disorders.Methods Eighty-four patients with WMH were included and divided into low burden group(45 cases),moderate burden group(17 cases)and high burden group(22 cases)by the Fazekas scale score.Gait and balance functions were comprehensively evaluated by stride length,stride width,gait speed and Tinetti performance-oriented mobility assessment(POMA)score.Pearson correlation was used to analyze the correlation of WMH in different burdens and regions of the brain with gait abnormalities and balance disorders.Results The high burden group had the shortest stride length,largest stride width,slowest gait speed,and lowest POMA score.The difference between groups was statistically significant(P<0.05).Pearson correlation analysis showed that periventricular WMH had a negative correlation with stride length,gait speed,and POMA score(r=-0.787,-0.480,-0.670,-0.435,-0.600,all P<0.01),and demonstrated a positive correlation with stride width(r=0.740,P<0.01).Deep WMH showed a negative correlation with gait speed,total score of POMA and Tinetti balance score(r=-0.402,-0.698,-0.795,all P<0.05).Conclusion WMH correlates with gait abnormalities and balance disorders.The increase of WMH burden is associated with shortened stride length,greater stride width,slower gait speed,and impaired gait and balance functions.Periventricular WMH is highly correlated with gait abnormalities,while deep WMH is strongly correlated with balance disorders.