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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:
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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]. 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]. 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
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