目的:筛查脑白质病变(white matter lesion,WML)的危险因素,探究 WML 与脑卒中和痴呆的关系。

方法:本研究共纳入经MRI检査存在WML的患者260例,无WML者60例,其中将WML患者按照 Fazekas 分级分为 3级。收集所有入组患者性别、年龄、文化程度,有无高血压、糖尿病、高脂血症、高同型半胱氨酸血症,是否超重,抽烟、饮酒史,有无脑卒中病史,应用多元有序logistic回归分析找出WML的危险因素;比较脑卒中患者的WML程度是否严重于非卒中患者;同时对入组患者用MMSE量表进行评分,分析脑白质病变与认知的关系。

结果:年龄、高血压病、高同型半胱氨酸血症、抽烟与WML 的严重程度相关。脑卒中患者的Fazekas分级与非脑卒中患者比较,有统计学差异(Z=-10.305,P=0.000);随着 Fazekas分级的增加,患者 MMSE评分下降(r_s=-0.511,P=0.000)。

结论:年龄、高血压、高同型半胱氨酸血症、抽烟是 WML 的独立危险因素:WML 或是脑卒中的预测信号;WML程度越重,患者痴呆风险越高。

Objective: To screen the risk factors of white matter lesion (WML) and explore therelationship between WML with stroke and dementia.

Methods: In this study, a total of 260 patients with WML and 60 without WML underwentMRl were collected. The patients with WML were divided into 3 grades according toFazekas scale. Gender, age,education level, hypertension,diabetes, hyperlipemia,hyperhomocysteinemia, overweight, smoking and drinking history, and stroke history ofall enrolled patients were collected. Multiple ordered logistic regression analysis was usedto identify the risk factors of WML. Compare whether the degree of WMl in strokepatients is more severe than in non-stroke patients. MMSE scale was used to score theenrolled patients, analyzed the relationship between WML and cognition.

Results: Age, history of hypertension, hyperhomocysteinemia and smoking were correlatedwith the severity of WML, The Fazekas classification of stroke patients was statisticallydifferent from that of non-stroke patients(2=-10.305,P=0.000). With the increase ofFazekas grading, the MMSE score ofpatients decreased(r_s-0.511,P=0.000).

Conclusion: Age, hypertension, hyperhomocysteinemia and smoking are independent riskfactors for WML. WM may be a predictive signal of stroke. The more severe the degree ofWML, the higher the risk of dementia in patients.