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目的研究血脂、尿酸、同型半胱氨酸(HCY)、糖化血红蛋白与脑小血管病(CSVD)的发生率及严重程度的相关性。方法选取在我院神经内科住院行头颅CT或MRI检查的患者602例,其中诊断为CSVD的患者142例,排除CSVD的患者460例。采用脑动脉脉动指数(PI)评估CSVD患者的严重程度,分为A组(PI<1.2,n=41)、B组(1.2≤PI<1.5,n=50)和C组(PI>1.5,n=51);另外460例患者为对照组。比较4组患者低密度脂蛋白胆固醇(LDLC)、高密度脂蛋白胆固醇(HDL-C)、尿酸、HCY和糖化血红蛋白水平,并分析这5项指标与CSVD发生率及严重程度的相关性。结果 4组患者LDL-C、HDL-C、尿酸、HCY、糖化血红蛋白(GHbAc)水平比较差异均有统计学意义(均P<0.05)。采用多因素Logistic回归分析结果显示,LDL-C、HCY、糖化血红蛋白是CSVD的危险因素。Pearson相关性分析结果显示,LDL-C(r=0.875,P=0.004)、尿酸(r=0.721,P=0.02)、HCY(r=0.734,P=0.01)、糖化血红蛋白(r=0.793,P=0.009)与CSVD严重程度呈正相关,HDL-C(r=-0.670,P=0.04)与CSVD严重程度呈负相关。结论LDL-C、HCY、糖化血红蛋白是CSVD发生的危险因素,LDL-C、尿酸、HCY、糖化血红蛋白促进CSVD的发生发展,而HDL-C对CSVD具有保护作用。
Objective To study the correlation between the incidence and severity of blood lipids, uric acid, homocysteine (HCY), glycated hemoglobin and cerebral vascular disease (CSVD). Methods A total of 602 patients were examined by skull CT or MRI in our department of neurology. There were 142 patients diagnosed as CSVD and 460 patients excluded CSVD. The severity of CSVD patients was assessed by cerebral arterial pulsation index (PI) and divided into group A (PI <1.2, n = 41), group B (1.2≤PI≤1.5, n = 50) and group C n = 51). Another 460 patients were control group. The levels of low density lipoprotein cholesterol (LDLC), high density lipoprotein cholesterol (HDL-C), uric acid, HCY and glycosylated hemoglobin in the four groups were compared. The correlation between the five indexes and the incidence and severity of CSVD was analyzed. Results There were significant differences in LDL-C, HDL-C, uric acid, HCY and GHbAc between the four groups (all P <0.05). Multivariate logistic regression analysis showed that LDL-C, HCY and HbA1c were risk factors of CSVD. Pearson correlation analysis showed that the levels of LDL-C (r = 0.875, P = 0.004), uric acid (r = 0.721, P = 0.02), HCY = 0.009) was positively correlated with the severity of CSVD. HDL-C (r = -0.670, P = 0.04) was negatively correlated with the severity of CSVD. Conclusions LDL-C, HCY and glycosylated hemoglobin are risk factors of CSVD. LDL-C, uric acid, HCY and glycosylated hemoglobin promote the development of CSVD, while HDL-C has a protective effect on CSVD.