大量基底核区扩大的血管周围间隙患者行走步态特点分析

Gait characteristics of patients with large numbers of enlarged perivascular spaces in the basal ganglia

目的探究基底核区大量扩大的血管周围间隙(BG-EPVS)患者行走时的步态特点及其与步态的关系。方法选取2020年12月1日至2022年1月31日首都医科大学附属北京朝阳医院神经内科住院的老年大量BG-EPVS(数量最多的基底核层面评估,单侧BG-EPVS>20个)患者99例为BG-EPVS组,老年非大量BG-EPVS(单侧BG-EPVS≤20个)患者193例作为对照组。比较2组步行速度、步行频率、跨步长、抬脚离地角度、步态稳定性参数和步态对称性,采用点二列相关和多元线性回归分析大量BG-EPVS与步态的关系。结果BG-EPVS组步行速度、步行频率、跨步长和抬脚离地角度、落脚控制明显低于对照组,差异有统计学意义(P<0.01),2组的跨步时间变异和跨步长变异比较,无统计学差异(P>0.05)。2组左侧脚步行速度、步行频率、跨步长和抬脚离地角度与右侧比较,无统计学差异(P>0.05)。校正混杂因素后,大量BG-EPVS与步行速度、跨步长、抬脚离地角度和落脚控制呈负相关(P<0.05,P<0.01),而与步行频率无关(r=-0.064,P=0.331)。多重线性回归分析显示,大量BG-EPVS是步行速度(β=-0.206,95%CI:-10.189~-2.060)、跨步长(β=-0.217,95%CI:-0.147~-0.039)、抬脚离地角度(β=-0.149,95%CI:-6.800~-0.005)、落脚控制(β=-0.179,95%CI:-0.570~-0.053)的独立危险因素(P<0.05,P<0.01)。结论大量BG-EPVS患者步行速度更慢,跨步长更短,抬脚离地角度更小,步态稳定性更差,而步态对称性无改变。

Objective To explore the gait characteristics of patients with large numbers of BG-EPVS and the relationship between large numbers of BG-EPVS and gait.Methods A total 292 elderly patients with large number of BG-EPVS admitted to our department from December 1,2020 to Jan 31,2022 were recruited,and 99 of them with the largest BG-EPVS>20 on the unilateral side were classified into BG-EPVS group,and the other 193 patients with BG-EPVS≤20 were classified into the control group.The gait speed,cadence,stride length,pre-swing angle,gait stability and gait symmetry were compared between the two groups.Point biserial correlation and multiple linear regression analyses were used to analyze the relationship between large numbers of BG-EPVS and gait.Results The patients of the BG-EPVS group had significantly lower gait speed and cadence,shorter stride length,smaller pre-swing angle and poorer foot fall than those of the control group(P<0.05),but no such differences were seen in stride time variability or stride length variability between them(P>0.05).There were no statistical differences in gait speed and cadence,stride length,or pre-swing angle between the left and right sides in an individual from both groups(P<0.05).After adjustment for confounding factors,large number of BG-EPVS was negatively correlated with gait speed,stride length,pre-swing angle and foot fall(P<0.05,P0.01),but had no relation with gait cadence(r=-0.064,P=0.331).Multiple linear regression analysis showed that large number of BG-EPVS was an independent risk factor(P<0.05)for lower gait speed(β=-0.206,95%CI:-10.189--2.060),shorter stride length(β=-0.217,95%CI:-0.147--0.039),smaller pre-swing angle(β=-0.149,95%CI:-6.800--0.005)and poorer foot fall(β=-0.179,95%CI:-0.570--0.053).Conclusion The patients with large numbers of BG-EPVS have lower gait speed,shorter stride length,smaller pre-swing angle and poorer gait stability,but their gait symmetry has no such changes.