Association Of Cerebral White Matter Lesions With Serum Uric Acid Levels And Cystatin C

Background:Cerebral white matter lesions(WMLs),also known as leukoaraiosis,is a common finding on brain imaging especially in the elders.WMLs can be divided into two types:periventricular WMLs(P-WMLs)and deep WMLs(D-WMLs)by the location.It was reported to be related to stroke,vascular dementia and depression.Therefore,it is important to identify the risk factors of WMLs and provide novel strategies for the prevention and treatment of WMLs.It was reported that increased serum uric acid(UA)and cystatin C(CysC)levels were closely related to cardio-cerebrovascular diseases.Excess accumulation of serum UA was associated with diabetes mellitus,hypertension and hyperlipemia.Elevated serum CysC levels were associated with lacunar infarction and cognitive impairment.Recently,elevated UA was associated with increased burden of white matter lesions pathology.Other studies have found that with the higher grade of WMLs,the level of serum CysC was also increased.Herein,we hypothesized that the increase of serum UA and CysC levels were closely associated with WMLs.To test our hypothesis,we firstly explored the controversial associations between WMLs and serum UA/CysC levels and secondly explored whether there was different impact of serum UA/CysC levels on different location of WMLs(P-WMLs and D-WMLs),which has not been reported yet.Materials and Methods:1.Consecutive inpatients older than 50 admitted to the Department of neurology of Dapping Hospital from July 2014 to March 2015 were enrolled in this study.2.Clinical information including demographic data,data of laboratory tests and brain MRI results were collected on all patients.3.The severity degree of P-WMLs and D-WMLs were rated using the modified visual scale of Fazekas.4.Multivariate Logistic regression analyses were performed to estimate the associations of WMLs and serum UA,serum CysC and other variables including age,gender,hypertension,diabetes,current smoking and alcohol consumption.Results:1.A total of 480 eligible participants were enrolled in the study of association between UA and WMLs.The mean age was 65.59 ±9.10 years and there were 193(40.21%)male gender.Older age were shown in the severe WMLs groups.2.Serum UA level in severe P-WMLs group(320.21 ±79.97)?mol/L was much higher than that in mild P-WMLs group(286.29±70.18)?mol/L;serum UA level in severe D-WMLs group(314.71 ±74.74)?mol/L was also much higher than that in mild D-WMLs group(290.07 ±74.04)?mol/L.These data indicate that patients with higher serum UA levels are related to higher severity of WMLs.3.For male patients,there was an increased trend of serum UA level with the increase severity of P-WMLs and D-WMLs,despite there was no statistical significance.For female patients,serum UA level in severe P-WMLs group(295.36 ±65.25)?mol/L was much higher than that in mild P-WMLs group(270.02 ±65.76)?mol/L;there was an increased trend of serum UA level with the increase of severity of D-WMLs,despite there was no statistical significance.4.Multivariate logistic regression analyses showed that higher serum UA level,older age and hypertension were the independent risk factors for P-WMLs;male gender,older age and hypertension were the independent risk factors for D-WMLs.5.A total of 473 eligible participants were enrolled in the study of association between CysC and WMLs.The mean age was 65.66±9.11 years and there were 190(40.12%)male gender.Older age were shown in the severe WMLs groups.6.Serum CysC level in severe P-WMLs group(0.82±0.18)mg/L and moderate group(0.78±0.15)mg/L were much higher than that in mild P-WMLs group(0.73±0.14)mg/L;serum CysC level in severe D-WMLs group(0.82±0.18)mg/L and moderate group(0.79±0.16)mg/L were much higher than that in mild D-WMLs group(0.74±0.14)mg/L.7.Multivariate logistic regression analyses showed that higher serum CysC level,older age and hypertension were the independent risk factors for P-WMLs;higher serum CysC level,male gender,older age and hypertension were the independent risk factors for D-WMLs.Conclusions:1.The age,serum UA and CysC levels increased with the increase severity of WMLs;2.Higher serum CysC level,older age and hypertension were the independent risk factors for P-WMLs and D-WMLs;3.Elevated serum UA level was independently associated with greater odds of higher severity of P-WMLs,particularly in women.