摘要
目的 探讨脑血管储备(CVR)功能与老年人脑白质损伤的相关性.方法 选择2018年5月-2019年7月山东省济南地区年龄≥ 60岁的老年人315例,进行经颅多普勒(TCD)超声检查脑血流检测并计算CVR、屏气指数(BHI)、动脉搏动指数(PI).根据CVR分为CVR正常组(CVR ≥ 20％)206例、CVR受损组(CVR＜20％)109例.受试者进行头颅MRI扫描,评估脑室周围、皮质下和总脑白质高信号(WMH)体积,并进行Fazekas评分.结果 与CVR正常组相比,受损组脑室周围、皮质下和总WMH体积及Fazekas评分≥ 2分患病率均显著升高(P＜0.01).脑室周围、皮质下和总 WMH 体积分别与 CVR(r=-0.70、-0.66、-0.73,P＜0.01)、BHI(r=-0.64、-0.65、-0.68,P＜0.01)负相关;与PI正相关(r=0.60、0.65、0.65,P＜0.01).校正混杂因素后,脑室周围、皮质下和总WMH体积仍分别与CVR、BHI显著负相关(P＜0.01);与PI显著正相关(P＜0.01)o Logistic回归分析显示,与正常组相比,受损组脑室周围、皮质下和总Fazekas评分≥ 2发生的风险分别是1.96倍(95％CI:1.17～3.27,P＜0.01)、1.84倍(95％CI:1.11～3.05,P＜0.05)和2.33倍(95％CI:1.30-4.18,P＜0.01).结论 CVR受损是老年人脑白质损伤的独立危险因素.
Abstract
Objective To investigate the relationship between cerebrovascular reserve(CVR)capacity and white matter lesions in elderly people.Methods We included 315 participants aged ≥ 60 years in Jinan area of Shandong Province from May 2018 to July 2019.They underwent transcranial Doppler ultrasonography for assessing CVR,breath holding in-dex(BHI),and arterial pulsatility index(PI).According to CVR capacity,they were divided into normal CVR group(CVR ≥20％,n=206)and impaired CVR group(CVR＜20％,n=109).Magnetic resonance imaging was performed to evaluate pe-riventricular,subcortical,and total white matter hyperintensity(WMH)volumes and Fazekas scores.Results Compared with the normal CVR group,the impaired CVR group showed significantly higher volumes of periventricular,subcortical,and total WMHs and significantly higher proportions of Fazekas scores≥2(P＜0.01).Periventricular,subcortical,and total WMH volumes were negatively correlated with CVR(r=-0.70,-0.66,-0.73,P＜0.01)and BHI(r=-0.64,-0.65,-0.68,P＜0.01)and positively correlated with PI(r=0.60,0.65,0.65,P＜0.01).After adjusting for confounding factors,periv-entricular,subcortical,and total WMH volumes were still negatively correlated with CVR and BHI(P＜0.01)and positively correlated with PI(P＜0.01).The logistic regression analysis showed that the risks of periventricular,subcortical,and total Fazekas score ≥ 2 in the impaired CVR group were 1.96 times(95％confidence interval[CI]:1.17-3.27,P＜0.01),1.84 times(95％CI:1.11-3.05,P＜0.05),and 2.33 times(95％CI.1.30-4.18,P＜0.01)that of the normal CVR group,respectively.Conclusion Impaired CVR is an independent risk factor for white matter lesions in the elderly.
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