低密度脂蛋白胆固醇在脑小血管病中的临床意义及其与患者认知水平的关系

摘要

目的:观察并研究低密度脂蛋白胆固醇(LDL-C)与脑小血管病(CSVD)之间的相关性,及CSVD对患者认知水平的影响.方法:随机选取自2012年9月至2015年9月期间,在东营市东营区人民医院影像科检查的246人作为研究对象.其中男性151人,女性95人,平均年龄(52.1 ± 14.7)岁,根据患者头颅MRI或(和)颅脑CT对结果,将受试者分成3组,分别为脑白质病变(WML)组(86人)、腔隙性脑梗死(LI)组(53人)和对照组(107例).对入组病例进行简易智力量表(MMSE)检测以及蒙特利尔认知评分(MoCA)检测,记录结果并进行统计学分析.结果:与对照组相比,LI组患者和WML组患者在LDL-C、TG、TC等结果方面存在显著差异,而在LI组和WML组两组之间进行比较结果不具有统计学差异;在其余影响因素方面,三组之间进行两两比较的结果均不具有统计学差异(P>0.05);与对照组相比,WML组与LI组评分均明显减低,且差异具有统计学意义(P<0.05),但LI组与WML组两组之间比较结果未见明显差异(P>0.05);以各危险因素为自变量,LI或WML为因变量,行Logistic回归分析及配对资料相关分析发现,LDL-C的增高与LI和WML发生相关.结论:LDL-C是CSVD的重要危险因素.在高血脂患者中,应提高对CSVD的认识和警惕.在条件允许的情况下,建议患者行颅脑MRI或CT检查,排除CSVD的存在.通过降低低密度脂蛋白水平、改善小血管内皮功能、抗炎和神经保护措施对CSVD进行早期干预,以期减少临床不良事件的发生.%Objective:To observe and study the the correlation between low density lipoprotein cholesterin(LDL-C) and cerebral small vascular disease(CSVD), and study the influence of CSVD on the cognition of patients. Methods:246 patients(151 males and 95 females are included, and average age was(52.1 ± 14.7) years old), who have ever visited the people's hospital of Dongying district from September 2012 to September 2015, were se-lected and divided into 3 groups according to the MRI examination: White Matter Lesions(WML) group(86 pa-tients),Lacunar Infarction(LI) group(53 patients) and control group(107 patients). MMSE test and Montreal cognitive score(MoCA) were evaluated among the cases.The results was recorded and analyzed.Results:Compared with the control group,patients in the LI and WML group have a significantly difference on the factors LDL-C,TG and TC. No difference between the LI and WML group. No significant difference of other factors was found between the 3 groups(P>0.05). The MMSE and MoCA averaged score in the LI and WML group were significantly lower than that of the control group(P<0.05), but no significant difference between LI and WML group(P>0.05). When the various risk factors were considered as independent variables,LI or WML was taken as dependent varia-ble,it was found that the coincidence of LI and WML were related with the level of low density lipoprotein choles-terol in Logistic regression analysis and matching data correlation analysis. Conclusion:LDL-C is an important risk factor of CSVD. In patients with hyperlipidemia, the understanding and alert of CSVD should be improved.When conditions allow,cerebral MRI or CT examination is recommended to rule out the existence of CSVD.By lowering the level of low-density lipoprotein cholesterol(LDL-C), improving endothelial function, anti-inflammatory and neural protection measures,we expect to intervene CSVD earlier and reduce clinical adverse events.