摘要：

目的 初步探讨脑小血管病总体负荷与血浆同型半胱氨酸之间的关系。方法 选择 2015年1月至2017年10月入院的106例脑小血管病患者为观察对象，测定血浆同型半胱氨酸水平，根据MRI检查获得的腔隙性梗死、脑白质高信号、脑微出血和扩大的血管周围间隙共4项影像学标志，评价脑小血管病总体负荷。结果 根据脑小血管病总体负荷评分情况分为低负荷组（96例）和高负荷组（10例），高负荷组血浆同型半胱氨酸水平有高于低负荷组之趋势但未达到统计学意义（t=-1.702， P= 0.090）。单因素和多因素逐步法Logistic回归分析未能证实血浆同型半胱氨酸水平（OR=1.041，95%CI： 0.952~1.138； P=0.381）和高同型半胱氨酸血症（OR=3.132，95%CI：0.740~13.259； P=0.121）是脑小血管病总体负荷增加的危险因素。结论 未得出血浆同型半胱氨酸水平和高同型半胱氨酸血症是脑小血管病总体负荷增加的危险因素的结论，但血浆同型半胱氨酸作为预测脑小血管病的可能标志物，值得深入研究。

关键词: 大脑小血管疾病, 半胱氨酸, 危险因素, 回归分析

Abstract:

Objective To investigate preliminarily the relationship between the total burden of cerebral small vessel disease (cSVD) and plasma homocysteine (Hcy). Methods A total of 106 patients with cSVD were consecutively enrolled from January 2015 to October 2017. Plasma Hcy test were performed in all patients. The total burden of cSVD was calculated according to the severity of lacunar infarcts, white matter lesions, cerebral microbleeds and enlarged perivascular space according to MRI. Results Patients were divided into low burden group (96 cases) and high burden group (10 cases) based on total burden scores of cSVD. The level of Hcy in plasma of high burden group was seem to be higher than that in low burden group without significant difference (t = - 1.702, P = 0.090). Univariate and multivariate stepwise Logistic regression analysis showed that Hcy level of plasm (OR =1.041, 95%CI: 0.952-1.138, P=0.381) and Hyperhomocysteinemia (OR=3.132, 95%CI: 0.740-13.259; P=0.121) could not be proved to be risk factor of increasing cSVD burden. Conclusions Although plasma Hcy cannot be considered to be one of the risk factors for cSVD based on this study, plasma Hcy need to be further investigated as a potential biomarker for cSVD.

Key words: Cerebral small vessel diseases, Cysteine, Risk factors, Regression analysis