老年顱腦腔隙灶改變危險因素及與尿微量白蛋的相關(guān)性

邱欽圣　許團新

[摘要] 目的 探討老年顱腦腔隙灶改變的危險因素及與尿微量蛋白的相關(guān)性，為該病臨床診治提供依據(jù)參考。 方法 以2017年1月—2018年12月為時限，方便擇取該院及東莞東華醫(yī)院顱腦MR檢查可見腔隙灶改變的34例老年患者為實驗組，另擇取該院及東莞東華醫(yī)院同期34例顱腦MR示正常的老年健康志愿者為對照組，對比觀察兩組尿微量蛋白蛋水平，收集兩組臨床資料，Logistic回歸分析導致老年顱腦MR腔隙灶改變的危險因素。結(jié)果 實驗組高血壓病史85.29%、糖尿病史44.44%，血脂異常64.71%，吸煙史44.11%，飲酒史55.88%，尿微量白蛋白（23.46±0.82）mg/L，均高于對照組（χ2=10.713，5.682，7.335，4.923，3.268，t=6.293;P<0.05），Logistic示是老年顱腦MR腔隙灶改變獨立危險因素。結(jié)論 尿微量白蛋白水平升高是老年顱腦MR腔隙灶改變的獨立危險因素，此外也受高血壓、糖尿病與吸煙的影響，應(yīng)引起臨床重視，重點加強防治。

[關(guān)鍵詞] 頭顱MR;腔隙灶改變;尿微量白蛋白;危險因素

[中圖分類號] R5? ? ? ? ? [文獻標識碼] A? ? ? ? ? [文章編號] 1674-0742（2019）05（c）-0178-03

[Abstract] Objective To investigate the risk factors of cerebral ventricle changes in the elderly and its correlation with microalbuminuria， and provide evidence for clinical diagnosis and treatment of this disease. Methods From January 2017 to December 2018， 34 elderly patients with changes in luminal lesions in our hospital and Donghua Hospital of Dongguan were convenient chosen as experimental group. At the same time， 34 elderly healthy volunteers in Donghua Hospital with normal brain MR showed the control group. The urine microalbumin levels were compared between the two groups. The clinical data of the two groups were collected. Logistic regression analysis showed the risk factors of MR lesions in the elderly. Results The experimental group had a history of hypertension of 85.29%， a history of diabetes of 44.44%， a dyslipidemia of 64.71%， a history of smoking of 44.11%， a drinking history of 55.88%， and a urine microalbumin （23.46±0.82） mg/L， which were higher than the control group （χ2=10.713，5.682，7.335，4.923，3.268，t=6.293; P<0.05）， Logistic showed an independent risk factor for MR luminal changes in elderly patients. Conclusion The increase of urinary microalbumin is an independent risk factor for the changes of MR lesions in elderly patients. In addition， it is also affected by hypertension， diabetes and smoking. It should be given clinical attention and focus on strengthening prevention and treatment.

[Key words] Skull MR; Luminal lesion changes; Urine microalbumin; Risk factors

腔隙性腦梗死指腦實質(zhì)內(nèi)小穿支動脈病理改變引起管腔閉塞所導致的缺血性小梗死灶，由于壞死、液化的腦組織由吞噬細胞移走形成空腔而得名，是臨床常見腦血管疾病，數(shù)據(jù)統(tǒng)計約占全部腦梗死的25%[1]。該病累及范圍小，以多發(fā)性數(shù)毫米囊性病灶為主要病理改變，病因病機復雜，包括血管內(nèi)皮功能障礙損傷過程，其局灶性神經(jīng)癥狀與體征較輕，甚至無癥狀，顱腦MR可見腦部腔隙性病灶改變，是臨床診斷本病的重要標準[2]。尿微量白蛋白（MAU）能夠反映腎損傷情況，既往主要用于腎臟疾病早期診斷。近年有研究指出，MAU在全身性血管內(nèi)皮功能紊亂與血管通透性增加中也有表達[3]，因此，其與腔隙性腦梗死的發(fā)生與進展是否存在相關(guān)性，值得研究與探討。文章現(xiàn)以2017年1月—2018年12月該院及東莞東華醫(yī)院收治34患者為例，分析探討老年顱腦MR腔隙灶危險因素及與MAU相關(guān)性，報道如下。