| Part one Serum homocysteine’s correlation with the imaging features of patients with cerebral small vessel diseaseObjective:To investigate serum homocysteine’s correlation with the imaging features of patients with cerebral small vessel disease(cSVD).Methods:A total of 231 inpatients with cSVD from the department of neurology in Hebei General Hospital were consecutively enrolled from September 2016 to December 2018 in this study,all of whom had received serum homocysteine(Hcy)test,neuropsychological assessment,and brain magnetic resonance imaging(MRI)examination.The demographic and clinical data were collected,and imaging features of cSVD on MRI scans,including white matter hyperintensities(WMH),old lacunar infarcts(LI),cerebral microbleeds(CMBs),and enlarged perivascular spaces(EPVS)were rated and used to group the subjects accordingly.Statistical methods,such as Student t test,c~2 test,and logistic regression were adopted to explore the relationship between serum Hcy levels and the imaging features of cSVD in its sufferers.Results:1. In the 231 cSVD patients included in this study,the frequencies ofmoderate-severe WMH,old LI,CMBs,and moderate-severe EPVS were 140(60.6%),136(58.9%),95(41.4%),and 119(51.5%),respectively.Comparison of the baseline characteristics showed that,compared with the lower Hcy group(Hcy<13.9mmol/L),patients with higher Hcy levels(Hcy≥13.9mmol/L)displayed higher frequencies of moderate-severe WMH,old LI,CMBs,and moderate-severe EPVS(P<0.05).2.Logistic regression analyses showed that serum Hcy level was the independent risk factor for the moderate-severe WMH(OR=1.081,95%CI:1.023-1.143,P=0.005),old LI(OR=1.129,95%CI:1.065-1.197,P<0.001),CMBs(OR=1.054,95%CI:1.013-1.096,P=0.009),and moderate-severe EPVS(OR=1.063,95%CI:1.020-1.109,P=0.004).3.Spearman’s correlation analysis and linear trend test revealed that the level of serum Hcy was positively associated with the severity of the deep(r=0.337,P<0.001,P for trend<0.001)and periventricular WMH(r=0.364,P<0.001,P for trend<0.001),burdens of old LI(r=0.331,P<0.001,P for trend<0.001),CMBs(r=0.192,P=0.003,P for trend=0.001),and EPVS(r=0.288,P<0.001,P for trend=0.002)in a dose-independent manner.Part two Serum homocysteine’s correlation with the cognitive function of patients with cerebral small vessel diseaseObjective:To investigate serum Hcy’s correlation with the cognitive function of patients with cSVD.Methods:Mini-mental state examination(MMSE)and Montreal cognitive assessment(Mo CA)were performed in all the cSVD patients of the first section to assess their cognitive function.With the whole cohort being grouped by the quartiles of serum Hcy level,Spearman’s rank correlation analysis and linear trend test were adopted to explore Hcy’s correlation with total scores of MMSE and Mo CA.Linear regression and Spearman’s rank correlation analysis were used to analyse the association between serum Hcy levels and Mo CA scores of cSVD patients.Results:1. Spearman’s rank correlation analysis showed that the level of serumHcy quartiles was negatively associated with MMSE as well as Mo CA scores(P<0.05)in cSVD patients,both of which matched the linear trend(P for trend<0.001)by the linear trend test.2. Multiple linear regression analysis showed that serum Hcy was anindependent predictor of the decreasing of Mo CA scores in cSVD patients(B=-0.163,95%CI:-0.273~-0.052,P=0.004).3. Spearman’s rank correlation analysis suggested that serum Hcy levelwas inversely related to the performace on executive function(r=-0.334,P=0.020),attention(r=-0.261,P=0.011),and visuospatial ability(r=-0.253,P=0.036)in patients with cSVD.Conclusions:1.Serum Hcy contributes to the development of cSVD-related cerebral image changes and is associated with WMH,LI,CMBs,and EPVS in a dose-dependent manner.2.Serum Hcy level is a probable predictor of cognitive decline in patients with cSVD,involving the executive function,attention,and visuospatial ability.3. Serum Hcy may be an independent risk factor for the development of cSVD. |
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