脑白质高信号与步态异常和平衡障碍的相关性研究

赵跃华; 尹力; 张璠; 骆嵩; 屈洪党; 许力

doi:10.16766/j.cnki.issn.1674-4152.002980

脑白质高信号与步态异常和平衡障碍的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.002980

蚌埠医学院第一附属医院神经内科，安徽蚌埠 233004

基金项目:

安徽省教育厅人文社会科学基金项目 SK2018A0181

蚌埠医学院2021年度研究生科研创新计划项目 Byycxz21094

详细信息

通讯作者:
许力，E-mail：Xuli7292@163.com

中图分类号: R743
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出版历程
- 收稿日期: 2022-12-01

Correlation of white matter hyperintensity with gait abnormalities and balance disorders

Department of Neurology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨不同负担、不同部位的脑白质高信号(WMH)与步态异常和平衡障碍的相关性。方法纳入2021年6月—2022年6月于蚌埠医学院第一附属医院神经内科住院治疗的WMH患者84例，根据Fazekas量表评分分为低负担组45例、中负担组17例和高负担组22例，测量步长、步宽、步速和Tinetti平衡与步态量表综合评估步态与平衡功能，应用Pearson相关性分析研究不同负担不同部位WMH与步态异常和平衡障碍的相关性。结果 WMH高负担组步长最短、步宽最长、步速最慢，Tinetti平衡与步态评分最低，组间比较差异有统计学意义(P < 0.05)。Pearson相关性分析显示脑室周围白质高信号(PWMH)与步长、步速、Tinetti总分、Tinetti平衡与步态测试评分呈负相关关系(r=-0.787、-0.480、-0.670、-0.435、-0.600, 均P < 0.01)，与步宽呈正相关关系(r=0.740, P < 0.01)；深部白质高信号(DWMH)与步速、Tinetti总分及Tinetti平衡评分呈负相关关系(r=-0.402、-0.698、-0.795, 均P < 0.05)。结论 WMH与步态异常和平衡障碍存在相关性，随WMH负担增加，表现为步长缩短、步宽增加、步速减慢，步态和平衡功能损害，PWMH评分与步态异常相关性较高，DWMH评分与平衡障碍相关性较高。
- 脑白质高信号 /
- 步态异常 /
- 平衡障碍
Abstract: Objective To assess the correlation of white matter hyperintensity (WMH) in different burdens and regions of the brain with gait abnormalities and balance disorders. Methods Eighty-four patients with WMH were included and divided into low burden group (45 cases), moderate burden group (17 cases) and high burden group (22 cases) by the Fazekas scale score. Gait and balance functions were comprehensively evaluated by stride length, stride width, gait speed and Tinetti performance-oriented mobility assessment (POMA) score. Pearson correlation was used to analyze the correlation of WMH in different burdens and regions of the brain with gait abnormalities and balance disorders. Results The high burden group had the shortest stride length, largest stride width, slowest gait speed, and lowest POMA score. The difference between groups was statistically significant (P < 0.05). Pearson correlation analysis showed that periventricular WMH had a negative correlation with stride length, gait speed, and POMA score (r=-0.787, -0.480, -0.670, -0.435, -0.600, all P < 0.01), and demonstrated a positive correlation with stride width (r=0.740, P < 0.01). Deep WMH showed a negative correlation with gait speed, total score of POMA and Tinetti balance score (r=-0.402, -0.698, -0.795, all P < 0.05). Conclusion WMH correlates with gait abnormalities and balance disorders. The increase of WMH burden is associated with shortened stride length, greater stride width, slower gait speed, and impaired gait and balance functions. Periventricular WMH is highly correlated with gait abnormalities, while deep WMH is strongly correlated with balance disorders.
- White matter hyperintensity /
- Gait abnormalities /
- Balance disorders
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表 1 3组WMH患者一般资料比较

Table 1. Comparison of General Data of Different Burden Groups of WMH

组别	例数	年龄(x±s, 岁)	性别(例)		高血压[例(%)]	糖尿病[例(%)]	吸烟史[例(%)]	饮酒史[例(%)]
组别	例数	年龄(x±s, 岁)	男性	女性	高血压[例(%)]	糖尿病[例(%)]	吸烟史[例(%)]	饮酒史[例(%)]
低负担组	45	57.73±6.94	22	23	11(24.4)	7(15.5)	16(37.7)	11(24.4)
中负担组	17	66.48±7.38	10	7	9(52.9)	4(23.5)	6(35.2)	6(35.2)
高负担组	22	73.85±4.79	11	11	17(77.2)	8(36.3)	9(40.9)	5(22.7)
统计量		39.041^a	0.504^b		17.416^b	3.665^b	0.553^b	0.936^b
P值		＜0.001	0.777		＜0.001	0.160	0.758	0.626
注：^a为F值，^b为χ²值。

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表 2 3组WMH患者步态结果比较(x±s)

Table 2. Comparison of gait results of three groups of WMH patients(x±s)

组别	例数	步长(cm)	步宽(cm)	步速(m/s)	Tinetti总分(分)	Tinetti平衡评分(分)	Tinetti步态评分(分)
低负担组	45	64.62±3.73	10.67±2.08	1.08±0.06	26.71±1.39	15.20±1.22	11.47±0.94
中负担组	17	61.35±5.09^a	12.41±2.60^a	1.07±0.06	24.41±1.33^a	13.12±1.58^a	11.29±1.16
高负担组	22	59.77±3.79^a	13.59±1.79^a	0.97±1.05^ab	22.59±1.05^ab	12.09±0.81^ab	10.50±1.19^ab
F值		11.775	14.929	22.759	77.926	53.909	6.325
P值		＜0.001	0.001	＜0.001	0.001	＜0.001	0.003
注：与低负担组比较，^aP<0.05；与中负担组比较，^bP<0.05。

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表 3 不同部位WMH患者步态结果比较(x±s)

Table 3. Comparison of gait results in different parts of WMH(x±s)

组别	例数	步长(cm)	步宽(cm)	步速(m/s)	Tinetti总分(分)	Tinetti平衡评分(分)	Tinetti步态评分(分)
PWMH组	46	61.50±3.86	12.39±2.15	1.04±0.09	24.8±2.16	13.74±1.86	11.03±1.16
DWMH组	38	62.75±4.88	11.92±2.59	1.05±0.09	24.8±2.17	13.61±1.76	11.18±1.16
t值		-1.681	1.172	-0.248	-0.008	0.451	-0.788
P值		0.095	0.243	0.804	0.994	0.653	0.432

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表 4 不同部位WMH与步态结果的相关性分析

Table 4. Correlation analysis of WMH and gait difference in different parts

组别	统计量	步长	步宽	步速	Tinetti总分	Tinetti平衡评分	Tinetti步态评分
PWMH组	r值	-0.787	0.740	-0.480	-0.670	-0.435	-0.600
	P值	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001
DWMH组	r值	-0.079	0.137	-0.402	-0.698	-0.795	-0.046
	P值	0.475	0.212	0.001	＜0.001	＜0.001	0.679

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