White Matter Lesions in Young-Middle Aged Migraineurs with Patent Foreman Ovale: A Case-Control Study

Background:White matter lesion(WML)is common in aging brain and is associated with cognitive impairment and dementia.However,recent studies reported an association between patent foramen ovale(PFO)and WML in migraineurs,especially in young,middle-aged migraineurs.Our retrospective,case-control study aims to describe the clinical characteristics of WML in this population and to explore potential risk factors.Methods:226 patients with migraine and PFO were consecutively initially screened.Relevant factors were selected by the least absolute shrinkage and selection operator(LASSO)regression and multivariable logistic regression model.A Nomogram was employed to visualize the prediction model conveniently.The discrimination and calibration abilities were evaluated using the Receiver Operating Characteristic(ROC)curve,the Hosmer-Lemeshow test,and calibration curves.Results:One hundred and nineteen participants were ultimately enrolled in our study,with a median age of 36.9±12.7 years and 80.7%of females.Brain magnetic resonance imaging MRI showed 67(56.3%)patients had WML,whereas 52(43.7%)patients were categorized into the non-WML group.LASSO regression screened out potential variables and subsequent multivariate analysisfinally identified age,mean platelet volume,andfibri-nogen(FIB)as independent predictive factors of WML.The area under the ROC curve(AUC)was 0.807.Hos-mer-Lemeshow test and calibration curve verified a consistency between the predicted and actual probability.Conclusion:The predictive nomogram established and validated in our study may assist clinicians in screening WML among young middle-aged migraineurs with PFO and developing individualized preventive and treatment strategies.

Significance of Increased CIMT with Coexisting Carotid Plaques in Cerebral White Matter Lesions in Elders

It is very common that increased carotid intima media thickness （CIMT） and carotid plaque coexist in a single subject in elderly patients with white matter lesions （WMLs）. In this study we inves- tigated whether the coexistence of increased CIMT and carotid plaque is more strongly associated with the presence and extent of WMLs than either alone. All patients were classified into 1 of the following 4 groups： without either increased CIMT （I） or carotid plaque （P）： I（-）P（-）; with only increased CIMT： I（＋）P（-）; with only carotid plaque： I（-）P（＋）; and with both increased CIMT and carotid plaque： I（＋）P（＋） The presence and severity of periventricular WMLs （PWMLs） and deep WMLs （DWMLs） were as- sessed and the prevalence of MRI findings by the Cochran-Armitage trend test was calculated. The characteristics of subjects showed that the percentages of patients with increased CIMT and carotid plaque in the DWMLs group and the PWMLs group were significantly higher than those without WMLs group. Both DWMLs and PWMLs were strongly associated with age, carotid plaque and CIMT. Furthermore, the Cochran-Armitage trend test indicated that the prevalence of MRI findings of PWMLs and DWMLs increased in the order of I（-）P（-）〈 I（＋）P（-）〈 I（-）P（＋）〈 I（＋）P（＋） （P〈0.0001）. For the pa- tients with DWMLs, the grades of both I（＋）P（-） and I（＋）P（＋） were increased significantly compared to I（-）P（-） （P〈0.0025, P〈0.05, respectively） without such a difference found in patients with PWMLs. Our results suggested that the coexistence of increased CIMT and carotid plaque is most closely associated with WMLs, and that increased CIMT is associated with the severity of DWMLs, whereas carotid plaque is related to the presence of WMLs.

Cornel iridoid glycoside protects against white matter lesions induced by cerebral ischemia via activation of neuregulin-1 pathway in rats

Ischemic stroke often elicits profound white matter lesions, which results in poor neurological outcomes and impairing the recovery in post-stroke. However, few studies have focused on white matter lesions caused by cerebral ischemia. The present study was aimed to investigate the effects of cornel iridoid glycoside(CIG), a main active component extracted from Cornus officinalis, on the white matter injury induced by ischemic stroke. CIG(60 and 120 mg·kg-1) were administered intragastrically 6 h after middle cerebral artery occlusion reperfusion(MCAO) surgery once a day for 7 d. A series of behavioral tests were carried out to evaluate the neurological function of MCAO rats. White matter structure was detected by luxol fast blue staining and transmission electron microscopy. Immunohistochemical staining was used to assess myelin loss, oligodendrocytes maturation and glial activation. Results showed that CIG remarkably decreased neurological deficit score, accelerated the recovery of somatosensory and motor functions, and ameliorated the memory deficit in MCAO rats. CIG alleviated white matter lesions and demyelination, increased myelin basic protein expression and the number of mature oligodendrocytes in the corpus callosum of MCAO rats. Besides, CIG inhibited the activation of microglia and astrocytes. Further data obtained by western blot analysis indicated that CIG increased the expression of brain-derived neurotrophic factor(BDNF)/p-Trk B, neuregulin-1/Erb B, and PI3 K p110α/p-Akt/p-m TOR in the corpus callosum of MCAO rats. Our findings demonstrated that CIG protected against white matter lesions induced by cerebral ischemia and the mechanisms were partially contributed to increasing BDNF and activating neuregulin-1/Erb B signaling and its downstream PI3 K/Akt/m TOR pathway in white matter.

White Matter Lesions Predict Recurrent Vascular Events in Patients with Transient Ischemic Attacks

Background： White matter lesions （WMLs） are common findings in brain magnetic resonance imaging （MRI） and are strongly associated with stroke incidence, recurrence, and prognosis. However, the relationship between WMLs and transient ischemic attacks （TIAs） is not well established. This study aimed to determine the clinical significance of WMLs in patients with TIA. Methods： A total of 181 consecutive inpatients with first-ever TIA were enrolled. Brain MRls within 2 days of symptom onset were used to measure WML volumes. Recurrent vascular events within 1 year of TIA onset were assessed. The relationship between WMLs and recurrent risk of vascular events was determined by a multivariate logistic regression. Results： WMLs were identified in 104 patients （57.5%）. Age and ratio of hypertension were significantly different between patients with and without WMLs. The incidence of vascular events in patients with WMLs significantly increased in comparison to those without WMLs （21.15% vs. 5.19%, 95% confidence interval [CI]： 1.18-[ 5.20, P = 0.027） after controlling for cont／~unders. Furthermore, distributions of WML loads were found to be different between patients who developed vascular events and those who did not. WML volumes were demonstrated to be correlated with recurrent risks, and the fourth quartile of WML volumes led to an 8.5-fold elevation of recurrent risk of vascular events compared with the first quartile （95% CI： 1.52-47.65, P = 0.015） alier adjusting for hyperlipidemia. Conclusion： WMLs occur frequently in patients with T1A and are associated wiila the high risk of recurrent vascular events, suggesting a predictive neuroimaging marker for TIA outcomes.

Features of hyperintense white matter lesions and clinical relevance in systemic lupus erythematosus

Background: Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease characterized by complex and various clinical manifestations. The study aimed to analyze clinical features and cerebral magnetic resonance imaging (MRI) changes of hyperintense white matter (WM) lesions in SLE patients.Methods: This was a retrospective study based on a consecutive cohort of 1191 SLE patients;273 patients for whom cerebral MRI data were available were enrolled to assess hyperintense WM lesions associated with SLE. Patients were assigned to two groups, ie, with or without hyperintense WM lesions. The MRI assessment showed that the hyperintense WM lesions could be classified into three categories: type A, periventricular hyperintense WM lesions;type B, subcortical hyperintense WM lesions;and type C, multiple discrete hyperintense WM lesions. The clinical and MRI characteristics were analyzed. Factors related to hyperintense WM lesions were identified by multivariate logistic regression analysis.Results: Among the 273 SLE patients with available cerebral MRI scans, 35.9% (98/273) had hyperintense WM lesions associated with SLE. The proportions of types A, B, and C were 54.1% (53/98), 11.2% (11/98), and 92.9% (91/98), respectively. Fifty-one percents of the patients showed an overlap of two or three types. Type C was the most common subgroup to be combined with other types. Compared with those without hyperintense WM lesions, the patients with hyperintense WM lesions were associated with neuropsychiatric SLE (NPSLE), lupus nephritis (LN), hypertension, and hyperuricemia (P = 0.002,P = 0.018,P = 0.045, andP = 0.036, respectively). Significantly higher rates of polyserous effusions and cardiac involvement were found in the patients with hyperintense WM lesions (P = 0.029 andP = 0.027, respectively), and these patients were more likely to present with disease damage (P < 0.001). In addition, the patients with hyperintense WM lesions exhibited a higher frequency of proteinuria (P = 0.009) and higher levels of CD8+ T cells (P = 0.005). In the multivariate logistic analysis, hyperuricemia and higher CD8+ T cells percentages were significantly correlated with hyperintense WM lesions in SLE patients (P= 0.019;OR 2.129, 95% confidence interval [CI] 1.313-4.006 andP < 0.001;OR 1.056, 95% CI 1.023-1.098, respectively).Conclusions: Hyperintense WM lesions are common in SLE patients and significantly associated with systemic involvement, including NPSLE, LN, polyserous effusions, cardiac involvement, and disease damage. Hyperuricemia and a higher number of CD8+ T cells were independent factors associated with hyperintense WM lesions in SLE.

Microstructural white matter lesion in Alzheimer's disease: a diffusion tensor imaging study using voxel-based analysis

Objective To study the microscopic changes of white matter and the relationship between white matter changes and cognitive impairment in Alzheimer’s disease(AD)using voxel-based analysis of DTI.Methods Thirty-seven patients with probable AD,and 32 normal controls(NC)were all examined by MMSE scores,and un-

脑白质病变与帕金森病患者临床症状的相关性研究

目的:探讨脑白质病变(white matter lesions,WML)对帕金森病(Parkinson’s disease,PD)患者运动症状、认知功能和情绪的影响。方法:纳入2018年1月至2023年12月就诊于安徽医科大学第二附属医院神经内科PD患者123例,应用年龄相关的白质改变(age-related white matter changes,ARWMC)量表评估患者头颅MRI影像学的脑白质病变程度,根据评分结果将患者分为轻度WML组(46例),中重度WML组(77例);使用帕金森病统一评定量表第三部分、Hoehn&Yahr(H-Y)分级量表评定运动症状及疾病严重程度,简易精神状态检查(mini-mental state examination,MMSE)评估PD的认知功能,汉密尔顿抑郁量表,汉密尔顿焦虑量表评定情绪状态,Barthel指数评定患者日常生活功能状态。比较两组患者的运动症状、认知及情绪评分等差异,应用Logistic回归分析PD患者的WML与临床症状的关系。结果:中重度WML组的高血压发生率(41.6%vs.23.9%,P<0.05)高于轻度WML组。中重度WML组的H-Y分级高于轻度WML组[2.5(1.5,3.0)vs.2.0(1.5,2.5),P<0.05],UPDRS-Ⅲ评分高于轻度WML组[(34.0±16.5)vs.(24.09±11.04),P<0.01]。此外,中重度WML组的MMSE评分低于轻度WML组[24.0(18.5,27.0)vs.26.0(23.8,27.0),P<0.01],Barthel得分亦低于轻度WML组[(77.4±17.4)vs.(83.5±11.7),P<0.05],差异有统计学意义。相关分析显示,ARWMC总分与HY及UPDRS-Ⅲ得分呈正相关,与年龄亦呈正相关。ARWMC总分与MMSE得分及Barthel评分呈负相关。Logistic回归分析显示,重度WML损害与认知障碍有相关性(回归系数β=1.072,95%CI=1.078~7.918,P=0.035)。结论:WML与PD运动障碍、认知功能损害及生活质量下降相关。

帕金森病伴脑白质病变患者临床特征及危险因素分析

目的探讨帕金森病(Parkinson disease,PD)伴脑白质病变(white matter lesions,WML)患者的临床特征和相关危险因素。方法选取2022年2月至2023年9月安徽医科大学附属宿州医院神经内科收治的PD患者127例,并收集患者临床资料。根据改良Fazekas评分量表将受试者分为正常组(n=15)、轻度异常组(n=43)、中度异常组(n=45)、重度异常组(n=24),比较4组临床资料差异,并进一步通过Spearman相关分析和多因素logistic回归分析研究PD患者WML严重程度的危险因素。结果4组性别、高血压、糖尿病、冠心病、抑郁自评量表评分、焦虑自评量表评分、帕金森病睡眠量表评分、尿酸、甘油三酯、总胆固醇、低密度脂蛋白胆固醇水平比较,差异均无统计学意义(P>0.05);4组年龄、帕金森病统一评分量表第三部分评分、Hoehn-Yahr分期、简易精神状态检查量表评分、蒙特利尔认知评估量表评分、同型半胱氨酸(homocysteine,HCY)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)水平比较,差异均有统计学意义(P<0.05)。年龄、帕金森病统一评分量表第三部分评分、Hoehn-Yahr分期和HCY水平与PD患者WML的严重程度呈正相关(r=0.759、0.319、0.378、0.545,P<0.01);简易精神状态检查量表评分、蒙特利尔认知评估量表评分及HDL-C水平与PD患者WML的严重程度呈负相关(r=-0.510、-0.524、-0.319,P<0.01)。年龄、HCY是PD患者WML严重程度的危险因素(P<0.05),HDL-C是PD患者WML严重程度的保护因素(P<0.05)。结论WML加重PD患者的运动症状和认知障碍,年龄、HCY是PD患者WML严重程度的危险因素,HDL-C是其保护因素。

初发小血管闭塞型脑梗死患者合并脑白质变性危险因素的研究

目的探讨初发小血管闭塞(SAO)型脑梗死患者合并脑白质变性(WML)的危险因素。方法选择2019年1月至2022年7月亳州市人民医院神经内科收治的150例初发SAO型脑梗死患者,根据WML情况将患者分为无WML组30例、轻度WML组52例和中重度WML组68例。回顾性分析三组患者的临床资料后采用多因素Logistic回归分析初发SAO型脑梗死患者合并WML的相关危险因素,ROC曲线分析相关危险因素对初发SAO型脑梗死患者合并WML的预测价值。结果三组患者年龄、高血压、尿酸水平、美国国立卫生研究院卒中量表评分差异有统计学意义(χ2/F=6.350、12.600、6.630、5.485,P<0.05)。多因素Logistic回归分析显示,高血压和年龄是初发SAO型脑梗死合并WML的危险因素(OR=7.039、1.090,P<0.01)。ROC曲线显示高血压和年龄预测初发SAO型脑梗死患者合并WML的AUC分别为0.691、0.698,最佳截断值分别为150/90 mmHg、56.50岁,约登指数分别为0.383、0.389,敏感度分别为73.52%、71.70%,特异度分别为68.42%、67.20%。结论高血压和年龄是初发SAO型脑梗死患者合并WML的危险因素,高血压和年龄对预测初发SAO型脑梗死患者合并WML均有一定价值。

脑白质病变及大脑皮层厚度与老年轻型卒中后认知功能障碍的相关性研究

目的探讨老年轻型卒中后认知功能障碍(PSCI)与脑白质病变、大脑皮层厚度的关系。方法回顾性分析158例老年轻型卒中病人的临床资料,根据MoCA评估结果分为非PSCI组和PSCI组(MoCA<26分),比较2组的基线资料、MRI影像改变、大脑皮层厚度,并采用多因素Logistic回归分析老年轻型卒中病人发生PSCI的影响因素。结果PSCI组与非PSCI组的腔隙性缺血灶、脑微出血、DWI阳性病变及血管间隙扩大检出率差异无统计学意义(P>0.05)。PSCI组年龄大于非PSCI组,脑白质病变较非PSCI组严重(P<0.05)。2组的左额下回三角部及右额下回三角部皮质厚度差异无统计学意义(P>0.05),但PSCI组左眶额部、右眶额部、左额中回及右额中回的皮质厚度均明显低于非PSCI组(P<0.05)。多因素分析显示,年龄、中重度脑白质病变均为老年轻型卒中病人发生PSCI的危险因素(OR=1.704、1.826,均P<0.05),前额叶脑皮质厚度(左眶额部、右眶额部、左额中回、右额中回)为老年轻型卒中病人发生PSCI的保护因素(OR=0.820、0.838、0.834、0.827,均P<0.05)。结论年龄、脑白质中重度病变及前额叶脑皮质厚度变薄均与PSCI密切相关,通过头颅MRI检查脑白质及大脑皮质厚度变化,可为临床预测PSCI的发生提供参考依据。

BDNF和HDL-C与老年帕金森病患者脑白质病变的关系

目的探讨血清脑源性神经营养因子(BDNF)和高密度脂蛋白胆固醇(HDL-C)与老年帕金森病(PD)患者脑白质病变(WML)的关系。方法筛选116例老年PD患者为研究组,依据Fazckas分级分成PD-WML组和PD组,另选取同期人口学资料匹配的40例健康体检者为对照组。比较不同组别的相关资料,应用多因素Logistic分析PD患者WML的影响因素,受试者工作特征(ROC)曲线分析血清BDNF、HDL-C与PD患者WML的关系。结果116例PD患者WML发生率为72.41%(84/116),Ⅰ、Ⅱ、Ⅲ级分别43、30、11例。PD-WML组年龄、高血压患病率、统一帕金森病评定量表Ⅲ(UPDRS-Ⅲ)评分均高于PD组(P<0.05),血清BDNF[(4.83±1.15)μg/L比(6.12±1.20)μg/L]、TC[(4.37±0.96)mmol/L比(4.84±1.04)mmol/L]和HDL-C[(1.07±0.29)mmol/L比(1.23±0.32)mmol/L]明显低于PD组(P<0.05)。年龄、高血压、BDNF和HDL-C是PD患者发生WML的独立影响因素(P<0.05)。对照组、PD组、WML轻度组(Ⅰ级)、WML中重度组(Ⅱ~Ⅲ级)血清BDNF、HDL-C均呈依次下降趋势(P<0.05),WML中重度组血清BDNF、HDL-C水平均明显低于WML轻度组(P<0.05)。血清BDNF、HDL-C以及联合诊断PD患者发生WML的曲线下面积(AUC)为0.834、0.768、0.899,单独诊断的截断值分别为5.70μg/L、1.15 mmol/L。血清BDNF、HDL-C以及联合诊断PD发生中重度WML的AUC为0.820、0.766、0.833,单独诊断的截断值分别为4.79μg/L、1.02 mmol/L。结论血清BDNF、HDL-C是PD患者发生WML的保护因素,可有效预测PD患者发生WML和评估病情严重程度。

基于“脾肾”脏腑理论探讨缺血性脑白质病变的病机及中医药治疗

近年缺血性脑白质病变的发病率逐年上升,该病早期症状隐匿且不典型,严重影响老年人群的生命及生活质量。目前西医的治疗手段主要是针对缺血性脑白质病变的基础病进行对症治疗,治疗较为局限且疗效欠佳,而中医在预防和改善缺血性脑白质病变临床症状方面有着独特的优势。基于脏腑理论,遵循“未病先防,既病防变”原则,结合临床经验,从脾肾两脏论治缺血性脑白质病变。通过调理脾肾,调和阴阳,达到治疗缺血性脑白质病变的目的。

MRI应用于阿尔茨海默病、血管性痴呆、混合型痴呆患者中血管损伤与脑萎缩评估的研究

目的对比血管损伤与脑萎缩在阿尔茨海默病(AD)、血管性痴呆(VD)或混合性痴呆(MD)患者中的分布,探究MRI在AD、VD、MD鉴别诊断中的价值。方法76例患者分别诊断为AD34例、VD31例和MD 22例。分别对三组通过分析MRI图像进行独立视觉评分量表和Evans's指数评估。结果与AD相比,MD的脑室周围白质病变PVL(P=0.002)、深部白质病变DWML(P=0.006)、皮质下微出血Juxtacortical MB(P=0.007)、深部白质微出血Deep MB(P=0.003)评分更高,VD的深部灰质病变DGML(p=0.016)、血管周围间隙PVS BG-CS(P=0.005)明显更多。VD与MD比较,血管性病变视觉评分结果无统计学差异,但VD患者内侧颞叶萎缩MTA(P<0.001)评分显著高于MD。脑皮层萎缩和Evans's指数的分布在组间无显著差异。结论MRI在痴呆患者的评估中可以更准确地检测血管病变及评估脑萎缩情况。研究证实血管病变在VD或MD患者中比AD更多,其中MD以深部和皮层旁微出血为主,这表明淀粉样脑血管病(CAA)可能是其主要的潜在病理机制。

腔隙性脑梗死合并脑微出血的危险因素与脑白质病变的相关性

目的 探讨腔隙性脑梗死(LI)合并脑微出血(CMBs)的危险因素及与脑白质病变(WML)的关系。方法 于2020年3月至2022年6月在海南省老年病医院收集LI患者134例,根据磁敏感加权成像(SWI)检测CMBs,分为CMBs组(49例)和非CMBs组(85例),利用脑白质病变量表评分(WMLs)分析LI患者脑白质病情情况与CMBs相关性,采用Logistic回归模型分析LI患者并发CMBs的危险因素。结果 134例LI患者合并CMBs发生率为36.57%(49/134例)。CMBs组WML发生率、WMLs评分明显高于非CMBs组(P<0.05);多因素Logistic回归分析显示,血尿酸、高血压史、高密度脂蛋白(HDL)、WML发生率和WMLs评分是LI患者发生CMBs的独立影响因素。且CMBs病灶数量与WMLs评分存在明显正相关(r=0.412,P<0.05)。结论 LI患者发生CMBs发生影响因素众多,控制血压、血脂水平以及降低血尿酸对于预防LI患者发生CMBs具有重要意义,且脑白质病变程度与CMBs严重程度紧密相关。

脑白质病变与急性缺血性卒中病人静脉溶栓后症状性颅内出血的关系

目的分析脑白质病变与急性缺血性卒中病人静脉溶栓后症状性颅内出血(symptomatic intracranial hemorrhage,sICH)的关系。方法回顾性分析400例符合溶栓治疗的急性缺血性卒中病例资料。根据磁共振成像,参考改良LA分级量表(age-related white matter changes,ARWMC)对脑白质病变进行量化评分。静脉应用重组人组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rt-PA)治疗后24h内复查头颅CT,根据是否发生sICH转化分为sICH组(n=29)与非sICH组(n=371)。比较两组脑白质ARWMC评分及病变体积差异,采用Logistic回归,分析病人溶栓后发生sICH的影响因素;绘制受试者工作特征曲线(receiver operating characteristic,ROC),分析脑白质ARWMC评分及病变体积对病人溶栓后发生sICH的预测效能。结果400例病人静脉溶栓后sICH发生率为7.25%(29/400)。sICH组糖尿病史占比、NIHSS评分、大动脉粥样硬化占比、纤维蛋白原水平、ARWMC评分及脑白质病变体积均大于非sICH组(P<0.05)。绘制ROC曲线发现:ARWMC评分、脑白质病变体积及两者联合预测病人发生sICH的曲线下面积(areaundercurve,AUC)分别为0.825、0.861、0.938。结论脑白质病变评分及体积,与急性缺血性卒中病人静脉溶栓后sICH有关,可作为其预测因子。

磁共振三维动脉自旋标记成像在血管性认知障碍患者血流动力学和预后评估中的应用

目的探讨磁共振三维动脉自旋标记成像在血管性认知障碍患者血流动力学和预后评估中的应用价值。方法选取缺血性脑小血管病60例患者的临床资料。使用MoCA量表认知功能评估并分为认知障碍组(30例)及认知正常为对照组(30例),采用不同PLD(1.5 s、2.5 s)行3D-ASL脑灌注成像,应用GE AW4.5工作站对双侧额叶、颞叶、顶叶、海马及颞顶交界处进行镜面对称测量(CBF_(1.5)、CBF_(2.5)),比较两组WMLs评分差异,分析WMLs评分/MoCA量表评分与各脑区CBF的相关性。结果认知障碍组WMLs评分明显高于对照组,差异有统计学意义(P<0.05)。与对照组相比,认知障碍组双侧额叶、颞叶、顶叶、海马及颞顶交界处的CBF_(1.5)值均明显较低,认知障碍组双侧额叶、颞叶与海马区的CBF_(2.5)值明显较低,差异有统计学意义(P<0.05)。对不同PLD下,认知障碍组患者的双侧额叶CBF_(1.5)与CBF_(2.5)值差异具有统计学意义(P<0.05)。双侧额叶CBF_(1.5)值/CBF_(2.5)值与WMLs评分呈显著负相关;双侧额叶、颞叶、海马CBF_(1.5)值及双侧额叶、海马、左侧颞叶CBF_(2.5)值与MoCA评分呈显著正相关(P<0.05)。结论3D-ASL技术中PLD=1.5 s指标下对识别VCI患者脑低灌注的敏感度较高,而PLD=2.5 s指标下特异度较高;WMLs与VCI严重程度呈正相关。

从“肾虚痰瘀”论治脑白质变性

脑白质变性(white matter lesions,WML)是常见的脑小血管病,以信息处理速度下降、行动迟缓和大小便异常为主要临床表现,临床发展为痴呆的可能性大。从“肾虚痰瘀”探析脑白质变性的机制与治疗,病性本虚标实,肾虚为本,髓海失养,精血化生不足,脑不得充,“技巧”不出;痰瘀阻络为标,多由肾虚气血化生不足,推动无力,痰瘀互结,闭阻脉络,脉络失养,形衰神减。临床治疗应紧抓该病的病机要点,培补肾精固其本,化痰通络祛其标,可提高临床疗效。

Wilson病患者合并脑白质病变临床相关的危险因素探讨

目的探讨Wilson病(WD)患者合并脑白质病变(WMLs)临床相关的危险因素。方法招募2022年8月至2023年6月期间在安徽中医药大学神经病研究所附属医院住院的43例WD合并WMLs患者作为研究组,以同时期住院的44例无WMLs的WD患者作为对照组,进行回顾性研究。比较两组患者一般资料、治疗前24 h尿铜、血清铜蓝蛋白、血清铁、血糖、血脂与同型半胱氨酸、尿酸、肌酐等临床检验指标间的差异,用二分类logistic回归分析筛选WD合并WMLs相关危险因素,Spearman相关性分析观察治疗前24 h尿铜与同型半胱氨酸之间的相关性。结果研究组患者的同型半胱氨酸、治疗前24 h尿铜高于对照组,差异有统计学意义(P<0.05),而两组患者的血清铜蓝蛋白、血清铁、血糖、血脂与尿酸、肌酐之间的差异无统计学意义(P>0.05)。二分类logistic回归分析显示同型半胱氨酸增高是WD合并WMLs的危险因素(OR=1.105,95%CI:1.013~1.205,P=0.024)。结论血清同型半胱氨酸增高是WD合并WMLs的危险因素。

静脉溶栓对脑梗死合并脑白质病变发生认知障碍的风险及疗效分析

目的 分析脑梗死合并脑白质病变(WML)患者静脉溶栓后认知障碍的发生风险及疗效。方法 回顾性分析静脉溶栓治疗的220例脑梗死合并WML患者临床资料。根据静脉溶栓治疗后认知功能情况分为障碍组(n=53)和无障碍组(n=167)。经多因素logistic回归分析,明确影响脑梗死合并WML患者静脉溶栓后认知功能的危险因素。结果 障碍组患者年龄≥60岁、卒中量表(NIHSS)评分≥9分、中度或重度WML占比及血清水通道蛋白(AQP4)水平高于无障碍组,miR-29b表达量低于无障碍组(P<0.05)。ROC曲线分析显示,血清miR-29b、AQP4均能预测脑梗死合并WML溶栓治疗后认知功能障碍的发生,曲线下面积分别为0.842、0.840(P<0.05)。经多因素logistic回归分析显示,年龄≥60岁、中度或重度WML、NIHSS评分≥9分、miR-29b表达量<0.895、AOP4水平≥33.695μg/L为脑梗死合并WML溶栓治疗后认知功能障碍的危险因素。结论 脑梗死合并WML静脉溶栓后认知功能障碍受年龄、WML程度、NIHSS评分、miR-29b表达量、AQP4水平的影响。