目的：分析急性脑梗死住院患者脑白质疏松症（leukoaraiosis,LA）的发病情况,探讨LA发生、发展的影响因素。方法：收集2016年12月至2018年12月上海交通大学医学院附属瑞金医院神经内科住院的急性缺血性卒中患者593例,根据脑室旁LA严重程度分为无LA组61例,轻度LA组324例,中重度LA组208例;又根据深部LA严重程度分为无LA组183例,轻度LA组257例,中重度LA组153例,分别比较脑室旁LA和深部LA各组临床特征的差异,Logistic回归分析影响LA的危险因素。结果：入选病例中,脑室旁LA的发生率为89.7%,深部LA的发生率为69.1%。在脑室旁LA分组中,3组患者的年龄、血尿素氮（blood urea nitrogen,BUN）、总胆固醇（total cholesterol,TC）、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol,LDL-C）、载脂蛋白AⅠ/载脂蛋白B（apolipoprotein AⅠ/apolipoprotein B, apoAⅠ/apoB）、同型半胱氨酸（homocysteine,Hcy）、 纤维蛋白原（fibrinogen, Fg）、高血压、既往卒中史相比较,差异有统计学意义（P<0.05）。年龄[优势比（odds ratio, OR）=4.41]、高血压（0R=1.94）、既往卒中史（0R=6.84）是中重度脑室旁LA的独立危险因素（均P<0.05）。在深部LA分组中,3组患者的年龄、BUN、TC、apoAⅠ/apoB、Hcy、高血压、既往卒中史比较,差异有统计学意义（均P<0.05）。年龄（OR=3.82）、Hcy水平（OR=1.04）、高血压（OR=1.96）、既往卒中史（OR=2.85）是中重度深部LA的独立危险因素（均P<0.05）。颅内外动脉硬化狭窄不是LA的影响因素。结论：年龄、高血压、既往卒中史是急性缺血性卒中住院患者中重度脑室旁和深部LA的独立危险因素。Hcy水平增高是此类患者中重度深部LA独立危险因素。

Objective To investigate the incidence and risk factors of leukoaraiosis (LA) in hospitalized patients with acute ischemic stroke（AIS）. Methods Five hundred and ninety-three hospitalized patients with AIS were divided into the non-LA group（n=61）, mild LA group（n=324）and moderate-severe LA group（n=208） according to the severity of paraventricular LA. Five hundred and ninety-three patients were also divided into non-LA group（n=183）, mild LA group（n=257） and moderate-severe LA group（n=153） according to the severity of deep LA. The differences in clinical characteristics between the paraventricular and deep groups were compared. The risk factors for LA in the patients with AIS were analyzed by multivariate Logistic regression. Results In the enrolled cases, the incidence of paraventricular LA was 89.7% and that of deep LA was 69.1%.In the paraventricular LA group, age, blood urea nitrogen(BUN), total cholesterol(TC), low-density lipoprotein cholesterol (LDL-C）, apolipoprotein AⅠ/apolipoprotein B (apoAⅠ/apoB）, homocysteine (Hcy）, fibrinogen (Fg), hypertension (Hcy), and previous stroke history of the 3 groups were compared, and the differences were statistically significant (all P<0.05). Age, hypertension, and previous stroke history were independent risk factors for moderate-severe paraventricular LA [odds ratio(OR)=4.41, 1.94, 6.84, all P<0.05]. In the deep LA group, age, BUN, TC, apoAⅠ/apoB, Hcy, hypertension, and previous stroke history of the 3 groups were compared and showed statistically significant differences (P<0.05). Age, serum Hcy level, hypertension, and past stroke history were independent risk factors for moderate to severe deep LA (OR=3.82, OR=1.04, OR=1.96, OR=2.85, all P<0.05). Conclusions Age, hypertension, and previous stroke history are independent risk factors for moderate-severe paraventricular and deep LA in hospitalized patients with AIS. Increased serum Hcy level is an independent risk factor for moderate-severe deep LA in the patients.