中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2011年
4期
285-290
,共6页
王月菊%侯宝元%董凌燕%李虹%李建中
王月菊%侯寶元%董凌燕%李虹%李建中
왕월국%후보원%동릉연%리홍%리건중
脑损害,慢性%认知障碍%危险因素%动脉硬化%脑白质疏松症
腦損害,慢性%認知障礙%危險因素%動脈硬化%腦白質疏鬆癥
뇌손해,만성%인지장애%위험인소%동맥경화%뇌백질소송증
Brain damage,chronic%Cognition disorders%Risk factors%Atherosclerosis%Leukoraiosis
目的 初步探讨不同程度脑白质损害(white matter lesions,WML)高龄患者的独立危险因素,为WML的进展提供预测依据.方法 根据Fazekas分级标准将151例74～93岁高龄老年人分为无白质损害组(对照组)、轻度脑白质损害组(轻度WML组)、中重度脑白质损害组(中重度WML组),采用单因素方差分析和多因素Logistic回归分析三组间认知评分、血管危险因素、脑动脉硬化和脑血流动力学、神经解剖等各项指标之间差异及独立危险因素.结果 三组间单因素方差分析显示,认知评分(F=48.595,P=0.000)、高血压(x2=7.052,P=0.029)、吸烟(x2=19.476,P=0.000)、总胆固醇(F=3.086,P=0.049)、Crouse积分(F=3.968,P=0.021)及多项脑萎缩指标差异有统计学意义.轻度WML组患者与对照组间多因素Logistic回归分析结果表明,吸烟(OR 2.031,95%CI 1.244～1.317)、腔隙性梗死(LI)数目(OR 2.031,95%CI L 316～4.015)、总胆固醇(OR 1.610,95%CI 0.972～2.668)为独立危险因素(P＜0.05);中重度WML组与轻度WML组间回归分析结果表明,认知评分(OR 0.276,95%CI 0.143～0.532)、吸烟(OR 2.262,95%CI 1.260～4.059)、大脑外侧裂比(OR 1.954,95%CI 1.013～3.768)为独立危险因素(P＜0.05).中重度WML组患者与对照组间回归分析结果显示,认知评分(OR 0.091,95%CI 0.030～0.273)、尾状核指数(OR 2.511,95%CI 1.147～5.499)、Crouse积分(OR 2.304,95%CI 1.127～4.712)、LI数目(OR 2.200,95%CI 1.028～4.707),为独立危险因素(P＜0.05).结论 轻度WML患者在认知功能、脑动脉硬化及脑萎缩等方面改变不显著,而中重度WML患者表现显著的认知功能障碍、脑动脉硬化和脑萎缩.与对照组比较,认知评分、尾状核指数、Crouse积分、LI数目是中重度WML患者的独立危险因素.
目的 初步探討不同程度腦白質損害(white matter lesions,WML)高齡患者的獨立危險因素,為WML的進展提供預測依據.方法 根據Fazekas分級標準將151例74～93歲高齡老年人分為無白質損害組(對照組)、輕度腦白質損害組(輕度WML組)、中重度腦白質損害組(中重度WML組),採用單因素方差分析和多因素Logistic迴歸分析三組間認知評分、血管危險因素、腦動脈硬化和腦血流動力學、神經解剖等各項指標之間差異及獨立危險因素.結果 三組間單因素方差分析顯示,認知評分(F=48.595,P=0.000)、高血壓(x2=7.052,P=0.029)、吸煙(x2=19.476,P=0.000)、總膽固醇(F=3.086,P=0.049)、Crouse積分(F=3.968,P=0.021)及多項腦萎縮指標差異有統計學意義.輕度WML組患者與對照組間多因素Logistic迴歸分析結果錶明,吸煙(OR 2.031,95%CI 1.244～1.317)、腔隙性梗死(LI)數目(OR 2.031,95%CI L 316～4.015)、總膽固醇(OR 1.610,95%CI 0.972～2.668)為獨立危險因素(P＜0.05);中重度WML組與輕度WML組間迴歸分析結果錶明,認知評分(OR 0.276,95%CI 0.143～0.532)、吸煙(OR 2.262,95%CI 1.260～4.059)、大腦外側裂比(OR 1.954,95%CI 1.013～3.768)為獨立危險因素(P＜0.05).中重度WML組患者與對照組間迴歸分析結果顯示,認知評分(OR 0.091,95%CI 0.030～0.273)、尾狀覈指數(OR 2.511,95%CI 1.147～5.499)、Crouse積分(OR 2.304,95%CI 1.127～4.712)、LI數目(OR 2.200,95%CI 1.028～4.707),為獨立危險因素(P＜0.05).結論 輕度WML患者在認知功能、腦動脈硬化及腦萎縮等方麵改變不顯著,而中重度WML患者錶現顯著的認知功能障礙、腦動脈硬化和腦萎縮.與對照組比較,認知評分、尾狀覈指數、Crouse積分、LI數目是中重度WML患者的獨立危險因素.
목적 초보탐토불동정도뇌백질손해(white matter lesions,WML)고령환자적독립위험인소,위WML적진전제공예측의거.방법 근거Fazekas분급표준장151례74～93세고령노년인분위무백질손해조(대조조)、경도뇌백질손해조(경도WML조)、중중도뇌백질손해조(중중도WML조),채용단인소방차분석화다인소Logistic회귀분석삼조간인지평분、혈관위험인소、뇌동맥경화화뇌혈류동역학、신경해부등각항지표지간차이급독립위험인소.결과 삼조간단인소방차분석현시,인지평분(F=48.595,P=0.000)、고혈압(x2=7.052,P=0.029)、흡연(x2=19.476,P=0.000)、총담고순(F=3.086,P=0.049)、Crouse적분(F=3.968,P=0.021)급다항뇌위축지표차이유통계학의의.경도WML조환자여대조조간다인소Logistic회귀분석결과표명,흡연(OR 2.031,95%CI 1.244～1.317)、강극성경사(LI)수목(OR 2.031,95%CI L 316～4.015)、총담고순(OR 1.610,95%CI 0.972～2.668)위독립위험인소(P＜0.05);중중도WML조여경도WML조간회귀분석결과표명,인지평분(OR 0.276,95%CI 0.143～0.532)、흡연(OR 2.262,95%CI 1.260～4.059)、대뇌외측렬비(OR 1.954,95%CI 1.013～3.768)위독립위험인소(P＜0.05).중중도WML조환자여대조조간회귀분석결과현시,인지평분(OR 0.091,95%CI 0.030～0.273)、미상핵지수(OR 2.511,95%CI 1.147～5.499)、Crouse적분(OR 2.304,95%CI 1.127～4.712)、LI수목(OR 2.200,95%CI 1.028～4.707),위독립위험인소(P＜0.05).결론 경도WML환자재인지공능、뇌동맥경화급뇌위축등방면개변불현저,이중중도WML환자표현현저적인지공능장애、뇌동맥경화화뇌위축.여대조조비교,인지평분、미상핵지수、Crouse적분、LI수목시중중도WML환자적독립위험인소.
Objective To investigate the independent risk factors of cerebral white matter lesions (WML) of different degrees in the elderly aged 80 years and over,and provide the evidences for forecasting the prognosis of WML.Methods Brain magnetic resonance images (MRI) findings in 151 people aged 74 to 93 years were collected and analyzed.According to the severity of WML in brain MRI using the Fazekas Scale,the persons were divided into non-WML (control) group,mildWML (grade 1 WML) group and moderate-to-severe WML (grade 2 WML) group.The cognitive score,vascular risk factors,cerebral hemodynamic and arteriosclerotic index,and radiological features were compared among the three groups.Subsequent one-way ANOVA and multivariate logistic analysis were performed to determine the statistically significant factors and the independent risk factors among groups.Results The statistically significant factors with one-way ANOVA analysis among the three groups were cognitive performance (F = 48.595,P = 0.000),hypertension (x2 =7.052,P=0.029),cigarette history (x2 = 19.476,P= 0.000),cholesterol (TC) (F= 3.086,P=0.049),Crouse score (F=3.968,P=0.021) and multiple cerebral atrophy indexes.When compared with control group,cigarette history (OR 2.031,95%CI 1.244-1.317),lacunar infarction (LI)numbers (OR 2.031,95%CI 1.316-4.015) and cholesterol (OR 1.610,95%CI 0.972-2.668) were independent risk factors in grade 1 WML group (all P＜0.05).The independent risk factors between grade 1 and 2 WML group were cognitive performance (OR 0.276,95%CI 0.143-0.532),cigarette history (OR 2.262,95% CI 1.260-4.059),and sylvian fissure ratio (SFR) (OR 1.954,95% CI 1.013-3.768) (all P＜0.05).The independent risk factors between the grade 2 WML group and control group were cognitive performance (OR 0.091,95%CI 0.030-0.273),bicoudate ratio (BCR)(OR 2.511,95%CI 1.147-5.499),Crouse score (OR 2.304,95%CI1.127-4.712)and LI numbers (OR 2.200,95%CI 1.028-4.707) (all P＜0.05).Conclusions Mild WML patients have no significant abnormalities in cognition,brain atrophy and cerebral atherosclerosis.Moderate to severe WML patients manifest remarkable cognitive disorder,cerebral atherosclerosis and brain atrophy.Compared with the controls,cognitive performance,BCR,Crouse score,LI numbers were the independent risk factors for moderate-severe WML patients.
