脑小血管病患者血清胱抑素C和甘油三酯与脑微出血及其严重程度的相关性

Correlation between Serum Cystatin C and Triglycerides Level with Cerebral Microbleeds in Patients with Cerebral Small Vessel Disease

摘要: 目的：探讨血清胱抑素C (CysC)和甘油三酯(TG)与近期皮质下小梗死患者(RSSI)脑微出血(CMBs)部位及严重程度的相关性。方法：选取2018年7月至2020年1月经青岛大学附属医院神经内科收治并予以头颅MRI检查诊断为RSSI合并CMBs的患者79例，同时选取同期于我院住院不合并CMBs的RSSI患者76例作为对照组。比较两组患者一般临床资料、实验室指标及影像学指标，利用多因素logistic回归模型分析RSSI患者合并CMBs的危险因素。在磁敏感加权成像(SWI)中根据CMBs病灶个数、部位不同进行严重程度和部位分组，分析TG、CysC及CysC/TG比值与CMBs的相关性。结果：单因素分析中CMBs阳性组患者高血压构成比、中重度脑白质高信号(WMH)构成比以及收缩压、总胆固醇、D-二聚体、TG、CysC水平较阴性组差异有统计学意义(P < 0.01)。多因素Logistic回归分析显示收缩压(OR = 1.019, 95%CI = 1.002~1.037)、中重度WMH (OR = 3.168, 95%CI = 1.488~6.741)、CysC (OR = 9.523, 95%CI = 1.656~54.756)以及TG (OR = 0.432, 95%CI = 0.228~0.821)均是RSSI患者合并CMBs的独立影响因素。随CMBs严重程度增加，CysC、TG及CysC/TG比值均呈现上升趋势，不同分组之间，CysC/TG比值具有统计学差异(P = 0.0412)。血清TG (r = −0.255, P = 0.001)、CysC (r = 0.223, P = 0.006)及CysC/TG比值(r = 0.359, P < 0.001)与CMBs病灶数量相关。不同部位血清TG、CysC水平及CysC/TG比值比较无统计学差异。结论：血清CysC水平升高和TG水平下降是RSSI患者合并CMBs的危险因素，且CysC/TG比值较CysC和TG单一指标与CMBs严重程度具有更好的相关性。

Abstract: Objective: To investigate the correlation between serum cystatin C (CysC) and triglycerides (TG) with the location and severity of cerebral microbleeds (CMBs) in patients with recent small subcor-tical infarction (RSSI). Methods: 79 patients admitted to the Department of Neurology of the Affili-ated Hospital of Qingdao University from July 2018 to January 2020 and diagnosed with RSSI com-bined with CMBs after MRI examination were selected, while 76 patients with RSSI not combined with CMBs who were hospitalized at the Affiliated Hospital of Qingdao University during the same period were selected as the control group. The general clinical data, laboratory data and imaging data of the two groups were compared, and the risk factors of combined CMBs in RSSI patients were analyzed using logistic regression models. According to the number of CMBs lesions and different locations, the patients were divided into groups based on severity and location, and the association between TG, CysC and the CysC/TG ratio with CMBs was analyzed. Results: Compared with the con-trol group, patients in the CMBs group had statistically significant difference in hypertension con-stituent ratios, moderate-to-severe cerebral white matter hyperintensities (WMH) constituent rati-os, systolic blood pressure, total cholesterol, D-dimer levels, TG, and CysC levels. Binary logistic re-gression analysis showed that systolic blood pressure (OR = 1.019, 95% CI = 1.002~1.037), moder-ate-to-severe WMH (OR = 3.168, 95% CI = 1.488~6.741), CysC (OR = 9.523, 95% CI = 1.656~54.756) and TG (OR = 0.432, 95% CI = 0.228~0.821) were all independent influencing factors for CMBs in patients with RSSI. CysC, TG, and CysC/TG ratios increased with increasing severity of CMBs, and the CysC/TG ratio was statistically different between different subgroups (P = 0.0412). Serum TG (r = −0.255, P = 0.001), CysC (r = 0.223, P = 0.006) and CysC/TG ratio (r = 0.359, P < 0.001) were signifi-cantly correlated with the severity of CMBs. There was no statistical difference in the comparison of serum TG, CysC levels and CysC/TG ratio at different location of CMBs. Conclusion: Elevated serum CysC and decreased TG were risk factors for CMBs in RSSI patients, and CysC/TG ratio had a better correlation with the severity of CMBs than both CysC and TG.