Incidence and risk factors for leukoaraiosis in hospitalized patients with acute ischemic stroke

doi:10.16138/j.1673-6087.2021.04.004

Abstract

Abstract:

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.

Key words: Leukoaraiosis, Ischemic stroke, Hypertension, Hyperhomocysteinemia, Vascular risk factor

CLC Number:

LI Qianqian, XIN Xiaoyu, TANG Huidong, WU Fang. Incidence and risk factors for leukoaraiosis in hospitalized patients with acute ischemic stroke[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(04): 240-245.

Figures/Tables 5

References 18

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年龄组	脑室旁LA	深部LA
<50岁	33（75.0）	22（50.0）
50~60岁	107（82.3）	68（52.3）
60~70岁	235（91.1）	189（73.2）
≥70岁	157（97.5）	131（81.4）
χ²	29.193	38.145
P	<0.001	<0.001

项目	无病变组（n=61）	轻度组（n=324）	中重度组（n=208）	H/χ²	P
年龄（岁）	57.52±8.31	63.48±8.88	65.51±8.01	36.649	<0.001
BMI（kg/m²）	24.39±2.69	23.64±3.16	24.45±3.13	0.295	0.863
BUN(mmol/L)	4.54±1.31	5.25±4.10	5.03±1.41	7.331	0.026
SCr(μmol/L)	73.70±18.65	77.60±45.39	77.61±27.50	0.254	0.881
UA(μmol/L）	303.72±93.43	307.70±82.61	306.04±88.50	0.027	0.987
TG(mmol/L)	1.59±1.25	1.82±1.23	1.78±1.19	2.017	0.365
TC(mmol/L)	4.76±1.37	4.77±1.07	4.53±1.06	7.166	0.028
HDL-C(mmol/L)	1.15±0.30	1.14±0.27	1.15±0.30	0.178	0.915
LDL-C(mmol/L)	3.02±1.10	3.03±1.39	2.84±1.55	9.413	0.009
apoAⅠ/apoB	1.38±0.48	1.43±0.60	1.50±0.46	6.978	0.031
Hb(g/L)	142.36±16.00	144.83±67.88	140.80±17.26	1.32	0.517
RDW（%）	13.24±0.66	14.20±11.53	13.51±0.96	4.741	0.093
Hcy(μmol/L)	12.10±5.16	13.57±7.97	14.39±7.79	7.666	0.022
Fg（g/L）	3.13±0.87	2.87±1.47	2.97±1.53	10.831	0.004
女性[n (%)]	12（19.7）	94（29.0）	62（29.8）	2.53	0.279
吸烟[n (%)]	23（37.7）	168（51.9）	101（48.6）	4.156	0.124
饮酒[n (%)]	21（34.4）	128（39.5）	68（32.7）	2.646	0.263
高血压[n (%)]	36（59.0）	220（67.9）	160（76.9）	8.999	0.011
糖尿病[n (%)]	16（26.2）	127（39.2）	69（33.2）	4.634	0.096
既往卒中史[n (%)]	2（3.3）	47（14.5）	58（27.9）	26.419	<0.001
房颤[n (%)]	4（6.6）	17（5.2）	7（3.4）	1.697	0.429
颅内外动脉狭窄[n (%)]	30（49.2)	193（59.6)	120（57.7)	2.276	0.321

项目	轻度组调整前 OR（95%CI）	P	中重度组调整前 OR（95%CI）	P	轻度组调整后 OR（95%CI）	P	中重度组调整后 OR（95%CI）	P
年龄	2.86(1.64~5.00）	<0.001	5.13(2.79~9.44）	<0.001	2.69(1.49~4.84）	0.001	4.41(2.31~8.42）	<0.001
BUN	1.34(1.07~1.67）	0.012	1.30(1.04~1.63）	0.023	1.29(1.02~1.64）	0.035	1.25(0.98~1.59）	0.075
Hcy	1.04(0.99~1.10）	0.125	1.06(1.00~1.12）	0.050	1.02(0.97~1.07）	0.428	1.03(0.98~1.09）	0.232
吸烟	1.78(1.01~3.12）	0.044	1.56(0.87~2.80）	0.136	2.16(1.16~3.99）	0.015	1.93(1.00~3.71）	0.050
既往卒中史	5.01(1.18~21.18)	0.029	11.41(2.70~48.21）	0.001	3.56(0.82~15.44）	0.089	6.84(1.58~29.67）	0.010
高血压	1.47(0.84~2057)	0.179	2.31(1.27~4.23）	0.006	1.35(0.75~2.43)	0.316	1.94(1.02~3.68）	0.043
颅内外动脉狭窄	1.52（0.88~2.64）	0.133	1.41（0.80~2.50）	0.240	1.41(0.79~2.51)	0.243	1.20(0.65~2.21)	0.569

项目	无病变组（n=183）	轻度组（n=257）	中重度组（n=153）	H/χ²	P
年龄（岁）	59.95±8.80	64.54±8.52	66.30±7.89	50.463	<0.001
BMI（kg/m²）	24.70±3.06	24.38±3.09	24.64±3.16	2.344	0.310
BUN(mmol/L)	4.69±1.21	5.45±4.56	5.00±1.43	9.019	0.011
SCr(μmol/L)	71.78±17.97	79.46±51.72	79.90±24.66	5.135	0.077
UA(μmol/L）	302.56±89.00	309.56±83.99	306.90±84.97	1.311	0.519
TG(mmol/L)	1.87±1.32	1.79±1.26	1.69±1.00	3.254	0.197
TC(mmol/L)	4.79±1.18	4.74±1.07	4.47±1.04	8.307	0.016
HDL-C(mmol/L)	1.12±0.25	1.16±0.29	1.15±0.32	1.541	0.463
LDL-C(mmol/L)	3.00±0.96	2.99±1.47	2.87±1.76	5.85	0.054
apoAⅠ/apoB	1.38±0.45	1.45±0.62	1.52±0.49	7.719	0.021
HGB(g/L)	142.26±14.94	144.94±76.00	141.26±17.62	2.102	0.350
RDW（%）	13.24±0.77	14.49±12.93	13.53±0.99	8.061	0.018
Hcy(μmol/L)	12.49±5.81	13.64±7.26	15.27±9.80	11.762	0.003
Fg（g/L）	3.02±1.90	2.80±0.63	3.04±1.75	1.878	0.391
女性[n (%)]	50（27.3）	82（31.9）	36（23.5）	3.447	0.178
吸烟[n (%)]	90（49.2）	121（47.1）	81（52.9）	1.318	0.517
饮酒[n (%)]	76（41.5）	85（33.1）	56（36.6）	3.294	0.193
高血压[n (%)]	109（59.6）	189（73.5）	118（77.1）	14.761	0.001
糖尿病[n (%)]	60（32.8）	100（38.9）	52（34.0）	2.024	0.363
既往卒中史[n (%)]	18（9.8）	40（15.6）	49（32.0）	29.633	<0.001
房颤[n (%)]	8（4.4）	16（6.2）	4（2.6）	2.705	0.240
颅内外动脉狭窄[n (%)]	114（62.3）	139（54.1）	90（58.8）	3.036	0.219

项目	轻度组调整前 OR（95%CI）	P	中重度组调整前 OR（95%CI）	P	轻度组调整后 OR（95%CI）	P	中重度组调整后 OR（95%CI）	P
年龄	2.51(1.67~3.76)	<0.001	4.34(2.59~7.29)	<0.001	2.37(1.54~3.64)	<0.001	3.82(2.19~6.65)	<0.001
BUN	1.27(1.10~1.47)	0.001	1.19(1.01~1.39)	0.034	1.20(1.02~1.42)	0.027	1.10(0.91~1.32)	0.332
SCr	1.01(1.00~1.02)	0.012	1.01(1.00~1.02)	0.013	1.00(0.99~1.01)	0.579	1.00(0.99~1.02)	0.471
Hcy	1.03(0.99~1.07)	0.070	1.05(1.02~1.09)	0.002	1.02(0.98~1.05)	0.344	1.04(1.00~1.08)	0.030
RDW	1.35(1.08~1.70)	0.009	1.33(1.06~1.67)	0.014	1.18(0.93~1.51)	0.18	1.17(0.91~1.49)	0.23
TC	0.96(0.81~1.14)	0.669	0.76(0.62~0.93)	0.008	1.02(0.81~1.27)	0.18	1.84(0.65~1.09)	0.20
apoAⅠ/apoB	1.42(0.94~2.15)	0.099	1.73(1.11~2.70)	0.017	1.37(0.81~2.33)	0.24	1.32(0.74~2.35)	0.35
既往卒中史	1.69(0.94~3.05)	0.082	4.32(2.39~7.82)	<0.001	1.29(0.70~1.40)	0.42	2.85(1.53~5.34)	0.00
高血压	1.89(1.26~2.83)	0.002	2.29(1.42~3.70)	0.001	1.77(1.15~2.71)	0.01	1.96(1.17~3.29)	0.01
颅内外动脉狭窄	0.712(0.48~1.05)	0.086	0.87(0.56~1.34)	0.517	0.66(0.44~0.99)	0.047	0.73(0.45~1.19)	0.207