摘要
目的探讨血浆纤维蛋白原水平与脑小血管病(CSVD)头部MRI总负荷的关系。方法回顾性连续纳入2021年5月1日至2022年4月30日解放军总医院神经内科医学部住院的小动脉硬化型CSVD患者134例为CSVD组,纳入同期与CSVD组年龄、性别相匹配、头部MRI未见急性病灶且不符合CSVD任一影像学负荷评分表现的年度健康体检者以及良性阵发性位置性眩晕、颈椎病等无脑血管疾病的中老年患者作为对照组。所有受试者年龄≥45岁,并完成了3.0T头部MRI全序列扫描。应用国际通用的CSVD MRI总负荷评分评估,对以下任一项表现者计1分:腔隙≥1个、Fazekas评分中深部脑白质高信号(WMH)评分≥2分和(或)脑室旁WMH评分为3分、深部或幕下脑微出血≥1个、中重度基底节区血管周围间隙扩大(EPVS),依此将所有受试者分为对照组(总负荷评分0分)52例、轻度CSVD组(总负荷评分1~2分)52例、中重度CSVD组(总负荷评分3~4分)82例。比较3组受试者一般资料的差异,包括年龄、性别、吸烟、饮酒、高血压病、糖尿病、总胆固醇、高密度脂蛋白、低密度脂蛋白、三酰甘油、纤维蛋白原水平,仅对3组受试者纤维蛋白原水平的差异进行两两比较。对所有受试者发生CSVD的因素进行单因素Logistic回归分析,将结果中P<0.05的参数纳入多因素Logistic回归模型,进一步分析中老年人群发生CSVD的影响因素。结果3组受试者年龄、性别、吸烟史、饮酒史、高血压病史、三酰甘油水平的组间差异均无统计学意义(均P>0.05),3组糖尿病史、总胆固醇水平、高密度脂蛋白水平、低密度脂蛋白水平的组间差异均有统计学意义(均P<0.05)。纤维蛋白原水平由低到高依次为对照组[(2.5±0.4)g/L]、轻度CSVD组[(2.7±0.4)g/L]、中重度CSVD组[(3.1±0.6)g/L],3组纤维蛋白原水平的组间差异有统计学意义(F=19.307,P<0.01),且两两比较的差异均有统计学意义(P<0.05或P<0.01)。单因素Logistic回归分析结果显示,男性、年龄增加、饮酒、糖尿病、高密度脂蛋白水平、高纤维蛋白原水平与CSVD相关(均P<0.05);多因素Logistic回归分析表明,男性(OR=8.523,95%CI:3.345~21.714,P<0.01)、年龄增加(OR=1.063,95%CI:1.017~1.110,P=0.006)、饮酒(OR=4.701,95%CI:1.055~20.958,P=0.042)、糖尿病(OR=2.385,95%CI:1.009~5.634,P=0.048)、纤维蛋白原水平升高(OR=1.024,95%CI:1.014~1.035,P<0.01)是中老年人群发生CSVD的独立危险因素。结论纤维蛋白原水平与CSVD患者MRI总负荷相关,其水平升高可能增加发生CSVD的风险。本研究结果还需要多中心、大样本、前瞻性研究进一步证实。
Objective To investigate the relationship between plasma fibrinogen levels and total brain magnetic resonance imaging(MRI)burden in cerebral small vessel disease(CSVD).Methods A total of 134 patients with CSVD admitted to the Department of Neurology,Chinese People′s Liberation Army General Hospital from May 1,2021 to April 30,2022 were enrolled.Healthy subjects who matched the age and sex of the CSVD group,had no acute lesions on cranial MRI and did not meet any imaging load score of CSVD,and middle-aged and elderly patients without cerebrovascular diseases such as benign paroxysmal positional vertigo and cervical spondylosis were enrolled as the control group.All subjects were 45 years of age or older and completed full sequence scans of 3.0T brain MRI.The international CSVD MRI total load score was used,and a score of 1 was scored for any of the following:≥1 lacunar lesion,presumed vascular origin of deep white matter hyperintensity(WMH)≥2 points and/or paraventricular WMH score of 3 points in the Fazekas score,deep or infratentorial cerebral microbleeds≥1,and enlarged perivascular space(EPVS)in the basal ganglia.According to this,there were 52 cases in the control group(total MRI burden score 0),52 cases in the mild group(total MRI burden score 1-2),and 82 cases in the moderate to severe group(total MRI burden score 3-4).The general data of the three groups were compared,including age,gender,smoking history,drinking history,hypertension,diabetes mellitus,total cholesterol,high-density lipoprotein,low-density lipoprotein,triglyceride and fibrinogen levels.Only the differences in fibrinogen levels among the three groups were pairwise compared.Univariate Logistic regression analysis was performed to analyze the factors of CSVD in all subjects,and the parameters with P<0.05 in the results were included in the multivariate Logistic regression model to further analyze the influencing factors of CSVD in middle-aged and elderly people.Results There were no significant differences in age,gender,smoking history,drinking history,hypertension history and triglyceride level among the three groups(all P>0.05),but there were significant differences in diabetes mellitus,total cholesterol level,high density lipoprotein level and low density lipoprotein level among the three groups(all P<0.05).The levels of fibrinogen in the three groups were(2.5±0.4)g/L in the control group,(2.7±0.4)g/L in the mild CSVD group,(3.1±0.6)g/L in the moderate to severe CSVD group.The differences of fibrinogen levels among the three groups were statistically significant(F=19.307,P<0.01).The differences between the two groups were statistically significant(P<0.05 or P<0.01).Univariate Logistic regression analysis showed that there were significant differences in male,age,drinking history,diabetes mellitus,high density lipoprotein level and fibrinogen level(all P<0.05).Multivariate Logistic regression analysis showed that male(OR,8.523,95%CI 3.345-21.714,P<0.01),elderly age(OR,1.063,95%CI 1.017-1.110,P=0.006),drinking history(OR,4.701,95%CI 1.055-20.958,P=0.042),diabetes mellitus(OR,2.385,95%CI 1.009-5.634,P=0.048)and elevated fibrinogen(OR,1.024,95%CI 1.014-1.035,P<0.01)were independent risk factors for CSVD in middle-aged and elderly people.Conclusions Fibrinogen level is associated with the total MRI burden in patients with CSVD,and increased fibrinogen level may increase the risk of CSVD.The results of this study need to be further confirmed by multicenter,large-sample,prospective studies.
作者
杨华
范雪怡
梁骊
李敏
张舒凤
于瑾
李华
朱浩静
钱海蓉
Yang Hua;Fan Xueyi;Liang Li;Li Min;Zhang Shufeng;Yu Jin;Li Hua;Zhu Haojing;Qian Hairong(Navy Clinical College,the Fifth School of Clinical Medicine,Anhui Medical University,Hefei,Anhui 230032,China)
出处
《中国脑血管病杂志》
CAS
CSCD
北大核心
2022年第8期541-547,共7页
Chinese Journal of Cerebrovascular Diseases
基金
首都卫生发展科研专项(首发2020-2-5115)。
关键词
大脑小血管疾病
纤维蛋白原
磁共振成像
总负荷评分
Cerebral small vessel diseases
Fibrinogen
Magnetic resonance imaging
Total burden score
