摘要
目的探讨老年脑小血管病(CSVD)患者血浆胱抑素C(CysC)、总胆固醇、脂蛋白a水平及蛋白尿的变化特点。方法回顾性分析2016年9月-2018年8月在兰州大学第二医院神经内科住院的316例老年CSVD患者的临床资料,并进一步分为脑白质高信号组(113例)、腔隙性脑梗死组(101例)及脑微出血组(102例),选择同期头颅MRI无异常改变且无神经系统阳性体征的老年人102例为对照组,对各组的CysC、总胆固醇、脂蛋白a水平及蛋白尿阳性比例进行比较分析。结果CSVD组的CysC水平及蛋白尿阳性率[分别为(0.9±0.2)mg/L、31.2%]明显高于对照组[(0.8±0.2)mg/L、11.8%],而CSVD组总胆固醇水平[(3.9±1.0)mmol/L]明显低于对照组[(4.3±0.8)mmol/L],差异均有统计学意义(P<0.05)。亚组分析结果显示,脑白质高信号组的CysC水平及蛋白尿阳性率分别为(0.9±0.2)mg/L、29.2%,腔隙性脑梗死组分别为(0.9±0.2)mg/L、35.6%,脑微出血组分别为(0.9±0.1)mg/L、29.4%,均明显高于对照组;而脑白质高信号组、隙性脑梗死组、脑微出血组的总胆固醇水平(mmol/L)分别为3.9±1.1、3.9±1.0、3.8±0.8,均明显低于对照组,差异均有统计学意义(P<0.05);腔隙性脑梗死组脂蛋白a水平[(53.7±63.2)nmol/L]明显高于对照组[(37.0±49.5)nmol/L],差异有统计学意义(P<0.05)。校正了混杂因素后,CSVD多因素logistic回归分析显示,CysC、蛋白尿为CSVD的独立危险因素(P<0.05),总胆固醇为CSVD的保护因素,脂蛋白a与CSVD无明显相关性;亚组分析结果显示,总胆固醇为脑微出血的保护因素,脂蛋白a为腔隙性脑梗死的独立危险因素。结论CysC、脂蛋白a和蛋白尿可能是脑小血管病的危险因素,但脑白质高信号、腔隙性脑梗死和脑微出血的危险因素存在差异。
Objective To observe the characteristics in changes of cystatin C (Cys C),total cholesterol (TC),lipoprotein a [Lp(a)] and proteinuria levels and their significance in patients with cerebral small vessel disease (CSVD).Methods This was a retrospective study consecutively recruiting 316 patients with CSVD from September 2016 to August 2018 at Lanzhou University Second Hospital,including 113 with white matter hyperintensity (WMH),101 with lacunar infarction (LI) and 102 with cerebral microbleeds (CMB).One hundred and two elderly people without abnormal head MRI changes and positive signs of nervous system were selected as the control group.Cys C,TC,Lp(a) and proteinuria levels were measured and compared between the groups. Results Serum Cys C and proteinuria levels in CSVD group [(0.9±0.2) mg/L,99(31.2%)] were all significantly higher than those in control group [(0.8±0.2) mg/L,12(11.8%),P<0.05].While,serum TC levels in CSVD group [(3.9±1.0) mmol/L] was significantly lower than those in control group (P<0.05).Subgroup analysis showed that serum Cys C and proteinuria levels in the WMH group [(0.9±0.2) mg/L,33(29.2%),respectively],the LI group [(0.9±0.2) mg/L,36(35.6%),respectively] and the CMB group [(0.9±0.1) mg/L,30(29.4%),respectively] were significantly higher than those in control group (P<0.05).While,serum TC levels in WMH group,LI group and CMB group [(3.9±1.1) mmol/L,(3.9±1.0) mmol/L,(3.8±0.8) mmol/L,respectively] were significantly lower than those in control group (P<0.05).After adjustment for confounding factors,multiple logistic regression analysis showed that Cys C and proteinuria were independent risk factors for CSVD (P<0.05).Additionally,subgroup analysis showed that TC was independent protective factor for CMB (P<0.05),Lp(a) was independent risk factor for LI (P<0.05). Conclusions Cys C,Lp(a) and proteinuria may be risk factors for CSVD,but may not carry the same weight for WMH,LI and CMB.Meanwhile,TC is an independent protective factor for CMB.
作者
马玉梅
邓斌
亓斐
牛彦霞
王满侠
MA Yu-mei;DENG Bin;QI Fei;NIU Yan-xia;WANG Man-xia(Department of Neurology,Second Hospital of Lanzhou University,Lanzhou 730030,China;Department of Neurosurgery,999 Brain Hospital,Guangzhou 510000,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2019年第8期676-681,共6页
Medical Journal of Chinese People's Liberation Army
基金
甘肃省科技厅神经病学疾病精准诊疗国际合作项目([2017]2)
兰州市人才创新创业项目(2016-RC-54)~~
关键词
卒中
胱抑素
脂蛋白
胆固醇
危险因素
stroke
cystatin
lipoprotein
cholesterol
risk factors
