切换至 "中华医学电子期刊资源库"
高级检索
中华危重症医学杂志(电子版)

中华危重症医学杂志(电子版) ›› 2020, Vol. 13 ›› Issue (01) : 34 -38. doi: 10.3877/cma.j.issn.1674-6880.2020.01.007

所属专题： 文献；

论著

老年人群血清胱抑素C、同型半胱氨酸与脑白质疏松症的相关性研究
徐珂莹1, 归崎峰1, 杨云梅1,†()   
  1. 1. 310003　杭州，浙江大学医学院附属第一医院老年病科
  • 收稿日期:2019-10-29 出版日期:2020-02-01
  • 通信作者: 杨云梅
  • 基金资助:
    十三五国家重点研发计划项目(2018YFC2000301)

Association of serum cystatin C and homocysteine with leukoaraiosis in elderly population

Keying Xu1, Qifeng Gui1, Yunmei Yang1,†()   

  1. 1. Department of Geratology, the First Affiliated Hospital, College of Medicine, Zhejiang University, 310003 Hangzhou, China
  • Received:2019-10-29 Published:2020-02-01
  • Corresponding author: Yunmei Yang
  • About author:
    Corresponding author: Yang Yunmei, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

徐珂莹, 归崎峰, 杨云梅. 老年人群血清胱抑素C、同型半胱氨酸与脑白质疏松症的相关性研究[J/OL]. 中华危重症医学杂志(电子版), 2020, 13(01): 34-38.

Keying Xu, Qifeng Gui, Yunmei Yang. Association of serum cystatin C and homocysteine with leukoaraiosis in elderly population[J/OL]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2020, 13(01): 34-38.

目的

探讨老年人群血清胱抑素C和同型半胱氨酸与脑白质疏松症的关系，以寻找可靠的生物学标志物。

方法

收集2016年11月至2017年9月于浙江大学医学院附属第一医院老年病科住院的130例老年患者电子病历，记录所有患者的年龄、性别、高血压、高血压病程等一般资料和甘油三酯、总胆固醇、高密度脂蛋白、低密度脂蛋白、尿酸、胱抑素C及同型半胱氨酸等生化指标。采用半定量法将130例老年患者分为正常组（31例）、轻度异常组（26例）、中度异常组（32例）和重度异常组（41例）。采用Spearman相关分析年龄、高血压病程、尿酸、胱抑素C及同型半胱氨酸与脑白质疏松症严重程度的相关性；将年龄、高血压病程、尿酸、胱抑素C及同型半胱氨酸纳入Logistic多因素回归模型，分析影响脑白质疏松症严重程度的相关因素。

结果

正常组、轻度异常组、中度异常组及重度异常组老年患者年龄[（73 ± 6）、（72 ± 7）、（76 ± 6）、（79 ± 7）岁，F = 10.487，P < 0.001]、高血压病程[0（0，2）、4（0，16）、2（0，15）、10（0，15）年，H = 10.711，P = 0.013]、尿酸[（274 ± 74）、（294 ± 67）、（315 ± 64）、（343 ± 120）μmol/L，F = 3.964，P = 0.010]、胱抑素C[（0.96 ± 0.29）、（1.24 ± 0.32）、（1.42 ± 0.40）、（1.84 ± 0.65）mg/L，F = 23.025，P < 0.001]及同型半胱氨酸[（10.1 ± 2.3）、（11.4 ± 2.9）、（12.5 ± 2.7）、（18.0 ± 3.5）μmol/L，F = 39.271，P < 0.001]水平比较，差异均有统计学意义。进一步两两比较发现，重度异常组患者年龄较正常组、轻度异常组及中度异常组均显著增高（P均< 0.05）；轻、重度异常组患者高血压病程均较正常组显著延长（P均< 0.05）；轻度异常组患者胱抑素C水平较正常组显著升高（P < 0.05）；中度异常组患者胱抑素C及同型半胱氨酸水平均较正常组显著升高（P均< 0.05）；重度异常组患者胱抑素C及同型半胱氨酸水平均较正常组、轻度异常组及中度异常组显著升高（P均< 0.05）；且重度异常组患者尿酸水平均较正常组和轻度异常组显著升高（P均< 0.05）。相关分析结果显示，年龄（r = 0.406，P < 0.001）、高血压病程（r = 0.263，P = 0.002）、尿酸（r = 0.293，P = 0.001）、胱抑素C（r = 0.588，P < 0.001）及同型半胱氨酸（r = 0.646，P < 0.001）均与脑白质疏松症具有相关性。Logistic回归分析显示年龄[比值比（OR）= 1.099，95%置信区间（CI）（1.030，1.168），P = 0.003]、胱抑素C [OR = 11.345，95%CI（3.725，34.549），P < 0.001]及同型半胱氨酸[OR = 1.438，95%CI（1.262，1.638），P < 0.001]均为影响脑白质疏松症严重程度的危险因素。

结论

血清胱抑素C、同型半胱氨酸是老年患者脑白质疏松症的危险因素，可以初步评价其脑白质疏松症的严重程度。

关键词: 脑白质疏松症, 胱抑素C, 同型半胱氨酸, 老年人群
Objective

To investigate the association of serum cystatin C and homocysteine with leukoaraiosis in the elderly population to find reliable biomarkers.

Methods

Electronic medical records of 130 elderly patients admitted to the Department of Geratology of the First Affiliated Hospital, College of Medicine, Zhejiang University from November 2016 to September 2017 were collected. The general data (including age, gender, hypertension, and course of hypertension) and biochemical indicators (including triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, uric acid, cystatin C, and homocysteine) of all patients were recorded. Those 130 elderly patients were divided into a normal group (n = 31), a mildly abnormal group (n = 26), a moderately abnormal group (n = 32) and a severely abnormal group (n = 41) by a semi-quantitative method. The correlation among age, course of hypertension, uric acid, cystatin C, and homocysteine with the severity of leukoaraiosis was analyzed by Spearman correlation. Then age, course of hypertension, uric acid, cystatin C, and homocysteine were included in a Logistic multivariate regression model to analyze related factors affecting the severity of leukoaraiosis.

Results

Age [(73 ± 6), (72 ± 7), (76 ± 6), (79 ± 7) years, F = 10.487, P < 0.001], course of hypertension [0 (0, 2), 4 (0, 16), 2 (0, 15), 10 (0, 15) years, H = 10.711, P = 0.013], uric acid [(274 ± 74), (294 ± 67), (315 ± 64), (343 ± 120) μmol/L, F = 3.964, P = 0.010], cystatin C [(0.96 ± 0.29), (1.24 ± 0.32), (1.42 ± 0.40), (1.84 ± 0.65) mg/L, F = 23.025, P = 0.001], and homocysteine [(10.1 ± 2.3), (11.4 ± 2.9), (12.5 ± 2.7), (18.0 ± 3.5) μmol/L, F = 39.271, P < 0.001] of elderly patients in normal, mildly abnormal, moderately abnormal and severely abnormal groups were statistically significantly different. In further pairwise comparisons, the age of patients in the severely abnormal group was significantly higher than that in normal, mildly abnormal and moderately abnormal groups (all P < 0.05), and the course of hypertension in mildly and severely abnormal groups was significantly longer than that in the normal group (both P < 0.05). The level of cystatin C in the mildly abnormal group was significantly higher than that in the normal group (P < 0.05). The levels of cystatin C and homocysteine were significantly higher in the moderately abnormal group than in the normal group (both P < 0.05) and those indicators were significantly higher in the severely abnormal group than in normal, mildly abnormal and moderately abnormal groups (all P < 0.05). Meanwhile, the uric acid level in the severely abnormal group was significantly higher than that in normal and mildly abnormal groups (both P < 0.05). Correlation analysis showed that age (r = 0.406, P < 0.001), course of hypertension (r = 0.263, P = 0.002), uric acid (r = 0.293, P = 0.001), cystatin C (r = 0.588, P < 0.001), and homocysteine (r = 0.646, P < 0.001) were associated with leukoaraiosis. Logistic regression analysis showed that age [odds ratio (OR) = 1.099, 95% confidence interval (CI) (1.030, 1.168), P = 0.003], cystatin C [OR = 11.345, 95%CI (3.725, 34.549), P < 0.001], and homocysteine [OR = 1.438, 95%CI (1.262, 1.638), P < 0.001] were related factors affecting the severity of leukoaraiosis.

Conclusion

Serum cystatin C and homocysteine may be risk factors for leukoaraiosis in elderly patients, which can be used to preliminarily evaluate its severity.

Key words: Leukoaraiosis, Cystatin C, Homocysteine, Elderly population
表1 4组老年患者一般资料比较[M（P25，P75）]
组别 例数 年龄（岁， ± s） 性别比（例，男/女） 高血压[例（%）] 高血压病程（年）
正常组 31 73 ± 6 18/13 11（35.5） 0（0，2）
轻度异常组 26 72 ± 7 15/11 15（57.7） 4（0，16）a
中度异常组 32 76 ± 6 17/15 18（56.3） 2（0，15）
重度异常组 41 79 ± 7abc 25/16 28（68.3） 10（0，15）a
F/χ2/H值 ? 10.487 0.456 7.799 10.711
P值 ? <0.001 0.928 0.050 0.013
表2 4组老年患者血清学指标比较（ ± s）
组别 例数 甘油三酯（mmol/L） 总胆固醇（mmol/L） 高密度脂蛋白（mmol/L） 低密度脂蛋白（mmol/L） 尿酸（μmol/L） 胱抑素C（mg/L） 同型半胱氨酸（μmol/L）
正常组 31 1.32 ± 0.31 4.1 ± 1.1 1.06 ± 0.34 2.16 ± 0.82 274 ± 74 0.96 ± 0.29 10.1 ± 2.3
轻度异常组 26 1.54 ± 0.24 4.2 ± 1.3 1.13 ± 0.38 2.25 ± 0.90 294 ± 67 1.24 ± 0.32a 11.4 ± 2.9
中度异常组 32 1.33 ± 0.46 4.5 ± 1.2 1.21 ± 0.33 2.58 ± 1.00 315 ± 64 1.42 ± 0.40a 12.5 ± 2.7a
重度异常组 41 1.36 ± 0.51 4.3 ± 1.1 1.18 ± 0.37 2.26 ± 0.90 343 ± 120ab 1.84 ± 0.65abc 18.0 ± 3.5abc
F值 ? 0.463 0.566 1.104 1.314 3.964 23.025 39.271
P值 ? 0.709 0.638 0.350 0.273 0.010 <0.001 <0.001
表3 Logistic回归分析影响脑白质疏松症严重程度的相关因素
影响因素 回归系数 标准误 Wald值 P值 OR值 95%CI
年龄 0.094 0.031 8.983 0.003 1.099 1.030 ~ 1.168
高血压病程 0.011 0.018 0.352 0.553 1.011 0.975 ~ 1.048
尿酸 0.002 0.003 0.691 0.406 1.002 0.997 ~ 1.007
胱抑素C 2.429 0.568 18.272 <0.001 11.345 3.725 ~ 34.549
同型半胱氨酸 0.363 0.067 29.842 <0.001 1.438 1.262 ~ 1.638
1
Simoni M, Li L, Paul NL, et al. Age-and sex-specific rates of leukoaraiosis in TIA and stroke patients: population-based study[J]. Neurology, 2012, 79 (12): 1215-1222.
2
Schmidt R, Petrovic K, Ropele S, et al. Progression of leukoaraiosis and cognition[J]. Stroke, 2007, 38 (9): 2619-2625.
3
Srikanth V, Beare R, Blizzard L, et al. Cerebral white matter lesions, gait, and the risk of incident falls: a prospective population-based study[J]. Stroke, 2009, 40 (1): 175-180.
4
Curtze S, Haapaniemi E, Melkas S, et al. White matter lesions double the risk of post-thrombolytic intracerebral hemorrhage[J]. Stroke, 2015, 46 (8): 2149-2155.
5
胡新国，李娜，程玲，等.高龄患者缺血性脑白质疏松进展的相关危险因素分析[J].中华老年医学杂志,2011,30(7):537-539.
6
Singh D, Whooley MA, Ix JH, et al. Association of cystatin C and estimated GFR with inflammatory biomarkers: the heart and soul study[J]. Nephrol Dial Transplant, 2007, 22 (4): 1087-1092.
7
Shlipak MG, Sarnak MJ, Katz R, et al. Cystatin C and the risk of death and cardiovascular events among elderly persons[J]. N Engl J Med, 2005, 352 (20): 2049-2060.
8
Duan J, Murohara T, Ikeda H, et al. Hyperhomocysteinemia impairs angiogenesis in response to hindlimb ischemia[J]. Arterioscler Thromb Vasc Biol, 2000, 20 (12): 2579-2585.
9
Scheltens P, Barkhof F, Leys D, et al. A semiquantative rating scale for the assessment of signal hyperintensities on magnetic resonance imaging[J]. J Neurol Sci, 1993, 114 (1): 7-12.
10
Grueter BE, Schulz UG. Age-related cerebral white matter disease (leukoaraiosis): a review[J]. Postgrad Med J, 2012, 88 (1036): 79-87.
11
Avet J, Pichot V, Barthélémy JC, et al. Leukoaraiosis and ambulatory blood pressure load in a healthy elderly cohort study: the PROOF study[J]. Int J Cardiol, 2014, 172 (1): 59-63.
12
陈佳，刘小利，陈旭娇.血压和同型半胱氨酸对80岁及以上脑白质疏松症患者严重程度的影响[J].中华老年医学杂志,2014,33(8):903-904.
13
Denardo SJ, Gong Y, Nichols WW, et al. Blood pressure and outcomes in very old hypertensive coronary artery disease patients: an INVEST substudy[J]. Am J Med, 2010, 123 (8): 719-726.
14
Huang GX, Lu H, Zhou Y, et al. Association between cystatin C and SVD in Chinese population[J]. Neurol Sci, 2018, 39 (12): 2197-2202.
15
赵新秀，归崎峰，杨云梅.老年代谢综合征患者血栓前状态与脑白质疏松的相关性[J].中华老年医学杂志,2016,35(4):355-359.
16
Umegae N, Nagai A, Terashima M, et al. Cystatin C expression in ischemic white matter lesions[J]. Acta Neurol Scand, 2008, 118 (1): 60-67.
17
Zeng Q, Lin K, Yao M, et al. Significant correlation between cystatin C, cerebral infarction, and potential biomarker for increased risk of stroke[J]. Curr Neurovasc Res, 2015, 12 (1): 40-46.
18
Kanhai DA, de Kleijn DP, Kappelle LJ, et al. Extracellular vesicle protein levels are related to brain atrophy and cerebral white matter lesions in patients with manifest vascular disease: the SMART-MR study[J]. BMJ Open, 2014, 4 (1): e003824.
19
胡新国，李娜，程玲，等.高龄缺血性脑白质疏松症的危险因素分析[J].中国临床保健杂志,2011,14(3):227-229.
20
Seshadri S. Elevated plasma homocysteine levels: risk factor or risk marker for the development of dementia and Alzheimer's disease?[J]. J Alzheimers Dis, 2006, 9 (4): 393-398.
[1] 张晋伟, 董永红, 王家璇. 基于GBD2021 数据库对中国与全球老年人疝疾病负担和健康不平等的分析比较[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 708-716.
[2] 程莉, 章晓良. 血尿酸和胱抑素C与糖尿病视网膜病变患者合并糖尿病肾病的关系及影响因素[J/OL]. 中华肾病研究电子杂志, 2023, 12(04): 194-199.
[3] 何彬, 王静. 彩色多普勒超声血流参数、血清尿酸、胱抑素C对短暂性脑缺血发作患者颈动脉狭窄的诊断价值[J/OL]. 中华神经创伤外科电子杂志, 2023, 09(05): 289-294.
[4] 姚晏, 黄惠斌. 影像技术和分子生物标志物在重症患者骨骼肌质量评价中的应用[J/OL]. 中华重症医学电子杂志, 2022, 08(04): 371-377.
[5] 杨森, 阙玉梅, 丁莉, 王艺瑾, 侯庆宇. Hcy和AD7c-NTP在阿尔茨海默病诊断中的临床应用[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(04): 208-212.
[6] 罗彦妮, 陈浪, 莫励华, 韦宁, 罗纯, 黎彬如. 血清CysC、Hcy水平与帕金森病伴发脑白质病变的关系[J/OL]. 中华脑科疾病与康复杂志(电子版), 2023, 13(06): 340-345.
[7] 沈炎, 张俊峰, 唐春芳. 预后营养指数结合血清降钙素原、胱抑素C及视黄醇结合蛋白对急性胰腺炎并发急性肾损伤的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 536-540.
[8] 蔡琦, 雍永宏, 何花, 佘铜生, 俞慧. 三维斑点追踪技术联合血清同型半胱氨酸对冠心病患者左心功能的评估价值[J/OL]. 中华临床医师杂志(电子版), 2022, 16(05): 425-430.
[9] 杭中霞, 王朝霞, 孙琴, 李妮. 血清Irisin、TSH 及Hcy 在妊娠期甲状腺功能减退症诊断中的应用[J/OL]. 中华诊断学电子杂志, 2024, 12(04): 265-269.
[10] 程旭, 俞悦, 裴小华. 核素肾小球滤过率法在临床开展的现状与思考[J/OL]. 中华诊断学电子杂志, 2023, 11(02): 73-76.
[11] 王可珺, 李吉镇, 马标, 续慧超, 谌红珊, 刘雷. 肌酐/胱抑素C对晚期上皮性卵巢癌术后并发症的预测价值[J/OL]. 中华诊断学电子杂志, 2023, 11(01): 49-55.
[12] 何妍, 檀丽冰, 周雯, 魏敏, 连军松. 老年男性人群幽门螺杆菌感染与血脂谱的关联研究[J/OL]. 中华胃肠内镜电子杂志, 2024, 11(03): 171-175.
[13] 刘焕亮, 崔慧娟, 曹慧, 付源. 颈动脉狭窄处剪切率对高同型半胱氨酸血症患者脑梗死的预测价值[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(04): 317-322.
[14] 李洪远, 董书宇, 鹿寒冰. 血清Hcy、sdLDL-C、Lp-PLA2水平对短暂性脑缺血发作进展为急性脑梗死的预测效能[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(01): 40-48.
[15] 晏美娟, 邵礼晖. 高水平脂蛋白（a）与无“三高”老年人群小动脉硬化型脑小血管病的相关性研究[J/OL]. 中华脑血管病杂志(电子版), 2023, 17(05): 458-463.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号