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目的通过对脑白质疏松(LA)危险因素的相关分析,探讨其中糖代谢与LA相关性。方法选取2013年6月—2014年5月因各种原因入住舟山医院神经内科的患者,年龄50~80岁。测得糖化血红蛋白(HbA1c)水平,按其是否高于标准值,随机抽取升高及正常患者各100例。同时检测入组者空腹血糖(FPG)、低密度脂蛋白(LDL-C)、叶酸、维生素B12及同型半胱氨酸(HCY)。并对入组者进行头颅MR检查,通过MRIcro软件定量计算LA体积分数。采用Spearman检验分析各个因素与LA的相关性。再对其进行偏相关分析,进一步排除混杂因素影响,明确糖代谢异常的相关指标与LA严重程度间的关联。结果患者LA体积分数与年龄(r=0.28,P=0.00)、高血压病史(r=0.25,P=0.00)、糖尿病史(r=0.36,P=0.00)、卒中史(r=0.20,P=0.01)、空腹血糖(r=0.39,P=0.00)及HbA1c(r=0.68,P=0.00)呈正相关。在调整年龄、高血压及卒中史后,糖代谢异常仍与LA相关,其中HbA1c与LA的相关性最高(r=0.47,P=0.00)。结论年龄、高血压病史、卒中史、糖代谢异常与LA的严重程度相关,其中HbA1c与LA严重程度呈正相关。因此,糖代谢指标中HbA1c是LA一个重要的危险因素,且可能从脑缺血/低灌注(血管解剖因素)及血脑屏障因素两方面对LA的发生产生影响。
Objective To investigate the correlation between glycometabolism and LA by analyzing the risk factors of leukoaraiosis (LA). Methods From June 2013 to May 2014, patients admitted to Zhoushan Hospital for various reasons were aged 50 to 80 years old. The level of HbA1c was measured. According to whether the level of HbA1c was higher than the standard value, 100 cases of elevated and normal patients were randomly selected. At the same time, fasting plasma glucose (FPG), low density lipoprotein (LDL-C), folic acid, vitamin B12 and homocysteine (HCY) were also detected. The subjects underwent craniocerebral MR examination and LA volume fraction was calculated quantitatively by MRIcro software. Spearman test was used to analyze the association of each factor with LA. Then partial correlation analysis, to further rule out the influence of confounding factors, a clear correlation between glucose-related abnormalities and LA severity index. Results The correlation between LA volume fraction and age (r = 0.28, P = 0.00), history of hypertension (r = 0.25, P = 0.00), history of diabetes (r = 0.36, = 0.01), fasting blood glucose (r = 0.39, P = 0.00) and HbA1c (r = 0.68, P = 0.00) Abnormal glucose metabolism was still associated with LA after adjustment for age, hypertension and stroke history, with the highest correlation between HbA1c and LA (r = 0.47, P = 0.00). Conclusions Age, history of hypertension, history of stroke and abnormal glucose metabolism are related to the severity of LA. HbA1c is positively correlated with the severity of LA. Therefore, HbA1c is an important risk factor for LA in glycometabolism and may affect LA occurrence from both cerebral ischemia / hypoperfusion (vascular anatomy) and BBB.