马春丽　王以宁　张本卓

[摘要] 目的 探討脑小血管病的临床特点及相关因素。 方法 选择2018年1月至2019年12月在我院神经内科诊断治疗的患者1022例为研究对象，根据临床诊断分为脑小血管病组与非脑小血管病组。分析脑小血管病的临床特征，单因素及多因素分析脑小血管病的危险因素。 结果 1022例神经内科患者中，脑小血管病组314例（30.72%）。临床特征显示，51.59%的脑小血管病患者有脑卒中病史，72.61%的患者有高血压病史，49.04%的患者有高同型半胱氨酸血症;影像学结果显示，腔隙性脑梗死比例最高，其次为脑白质脱髓鞘。单因素分析结果显示，男性、年龄≥60岁、高血压病史、糖尿病病史、既往卒中史、TC升高、高LDL-C血症的患者脑小血管病发生率较高（P<0.05）。多因素分析结果显示，年龄≥60岁、高血压病史、TC水平升高是脑小血管病的独立危险因素（P<0.05）。 结论 脑小血管病在神经内科住院患者中比例相对较高，超过一半的患者有高血压病史和脑卒中病史，影像学结果以腔隙性脑梗死比例最高，其次为脑白质脱髓鞘;年龄≥60岁、高血压病史及TC水平升高是脑小血管病的独立危险因素。

[关键词] 脑小血管病;临床特点;腔隙性脑梗死;脑白质脱髓鞘

[中图分类号] R743          [文献标识码] B          [文章编号] 1673-9701（2021）09-0060-04

Clinical cohort research of cerebral small vessel disease and analysis on its related factors

MA Chunli1   WANG Yi′ning2   ZHANG Benzhuo1

1.Department I of Neurology， the Second Affiliated Hospital of Mudanjiang Medical University， Mudanjiang   157000， China; 2.Department I of Cardiology， the Second Affiliated Hospital of Mudanjiang Medical University， Mudanjiang 157000， China

[Abstract] Objective To investigate the clinical features and related factors of cerebral small vessel disease. Methods A total of 1022 patients diagnosed and admitted to the department of neurology of our hospital from January 2018 to December 2019 were selected as the research objects， and they were divided into the cerebral small vessel disease group and the non-cerebral small vessel disease group according to clinical diagnosis. The clinical features of cerebral small vessel disease were analyzed. Univariate and multivariate analysis of risk factors of cerebral small vessel disease were performed. Results Among 1022 cases in the department of neurology， there were 314 cases（30.72%） in cerebral small vessel diseases group. It was shown by clinical features that there was a history of stroke in 51.59% of patients with cerebral small vessel disease， there was a history of hypertension in 72.61% of patients， and there was hyperhomocysteinemia in 49.04% of patients. It was shown by medical imaging results that there was the highest proportion in lacunar cerebral infarction， followed by demyelination of white matter of brain. It was shown by univariate analysis that the incidence of cerebral small vessel disease was higher in male patients， age ≥60 years， with history of hypertension， diabetes， previous stroke， TC increasing and high-low-density lipoproteinemia（P<0.05）. It was shown by multivariate analysis that age ≥60 years old， with history of hypertension and TC increasing were independent risk factors of cerebral small vessel disease（P<0.05）. Conclusion The proportion of cerebral small vessel disease in inpatients in the department of neurology is relatively high， more than half of the patients have a history of hypertension and stroke， and the highest proportion of lacunar cerebral infarction in imaging results is followed by demyelination of white matter of brain. Age≥60 years old， with history of hypertension and TC increasing are independent risk factors of cerebral small vessel disease.

[Key words] Cerebral small vessel disease; Clinical features; Lacunar cerebral infarction; Demyelination of white matter of brain

脑小血管病是指脑内小血管病变导致的疾病，包括小动脉、微动脉、毛细血管和小静脉。目前广泛认为小血管病实际是脑小动脉及微动脉血管病，病变主要累及直径为30～800 μm范围内没有侧支吻合的解剖终末动脉，病变微小动脉的直径主要为100～400 μm[1-2]。病变导致阻塞或出血，导致脑组织缺血、血脑屏障受损、脑白质病变等[3]。患者可表现为腔隙性综合征、急性认知障碍、亚急性或隐匿起病并逐渐进展的认知损害、人格障碍、情感障碍等[4]。随着社会老龄化，加上脑小血管病大多起病隐匿，故该病越来越受到临床重视。本研究分析脑小血管病的临床特点及其相关因素，现报道如下。……