中老年人群脑小血管病总负荷的患病率及相关因素分析

doi:10.12183/j.scjpm.2025.1287

摘要/Abstract

摘要： 目的旨在通过探讨中老年人群脑小血管（CSVD）病总负荷患病率及影响因素,揭示风险因素模式,为防控提供依据。方法于2025年1—4月采用横断面研究,以社区居民健康档案随机抽样结合健康宣传自愿报名确定研究对象。用统一问卷收集人口学、病史、体力与饮食指标,安排检测及MRI检查。后续对CSVD总负荷患病情况进行描述,并采用单、多因素分析方法分析其总负荷相关因素。结果本研究共纳入451名中老年人群进行CSVD总负荷患病情况分析。CSVD总负荷评分0分248人（54.99%）,1分112例（24.83%）,2分65例（14.41%）,3分24例（5.32%）,4分2例（0.44%）;CSVD总负荷患病率（即总负荷评分≥1分）共203例（45.01%）,其中脑白质高信号142例（31.49%）,存在至少1个腔隙性梗死灶96例（21.29%）,存在至少1个脑微出血70例（15.52%）,基底节区血管周围间隙显著扩大108例（23.95%）。多因素logistic回归分析结果显示,年龄（≥60岁OR=1.933）、高血压史（OR=1.617）、糖尿病史（OR=1.811）、偏头痛史（OR=1.994）、BMI（24~<28 kg/m² OR=2.586,≥28 kg/m² OR=3.127）、空腹血糖（>6.1 mmol/L OR=1.887）、糖化血红蛋白（≥5.7% OR=1.704）、同型半胱氨酸（>15 μmol/L OR=1.768）、国际体力活动问卷评分（低级OR=1.887）、地中海膳食评分（评分高OR=0.548）是社区中老年人群CSVD总负荷患病的相关因素（均P<0.05）。结论本研究表明社区中老年人群CSVD患病形势严峻,多种常见健康问题为其风险因素,遵循地中海饮食模式或可降低风险。本研究结果为制定针对性防控策略指明方向。

关键词: 脑小血管病, 中老年, 总负荷评分, 社区, 影响因素

Abstract: Objective To investigate the prevalence of the total burden of cerebral small vessel disease (CSVD) and its associated factors in a community-dwelling, middle-aged and elderly population through a cross-sectional study, aiming to elucidate patterns of risk factors and provide evidence for prevention and control strategies. Methods A cross-sectional study was conducted from January to April 2025. Participants were recruited from community residents through random sampling based on health records, supplemented by voluntary participation following health awareness campaigns. Data on demographics and medical history were collected using a standardized questionnaire. Physical activity and dietary metrics were obtained through guided self-administered questionnaires. All participants underwent laboratory examinations and magnetic resonance imaging (MRI). The prevalence of the total CSVD burden was described, and univariate and multivariate analyses were performed to identify associated factors. Results A total of 451 middle-aged and elderly individuals were included in the final analysis. Regarding the total CSVD burden score, 248 participants (54.99%) had a score of 0, 112 (24.83%) had a score of 1, 65 (14.41%) had a score of 2, 24 (5.32%) had a score of 3, and 2 (0.44%) had a score of 4. The overall prevalence of CSVD (total burden score ≥1) was 45.01% (n=203). Among the specific CSVD markers, white matter hyperintensities were present in 142 individuals (31.49%), at least one lacunar infarct was observed in 96 (21.29%), at least one cerebral microbleed was detected in 70 (15.52%), and significant enlargement of perivascular spaces in the basal ganglia was found in 108 (23.95%). Multivariate logistic regression analysis revealed that age (≥60 years, OR=1.933), a history of hypertension (OR=1.617), a history of diabetes mellitus (OR=1.811), a history of migraine (OR=1.994), BMI (24 to <28 kg/m², OR=2.586; ≥28 kg/m², OR=3.127), fasting blood glucose (>6.1 mmol/L, OR=1.887), HbA1c (≥5.7%, OR=1.704), Hcy (>15 μmol/L, OR=1.768), low physical activity level based on the IPAQ (OR=1.887), and a higher Mediterranean Diet (MED) score (OR=0.548) were significantly associated with the prevalence of the total CSVD burden in this community-based population (all P<0.05). Conclusions The findings of this study indicate a substantial prevalence of CSVD in the community-dwelling, middle-aged and elderly population. Multiple common health issues were identified as significant risk factors. Adherence to a Mediterranean dietary pattern may be associated with a reduced risk. These results highlight potential directions for the formulation of targeted prevention and control strategies.

Key words: Cerebral small vessel disease, Middle-aged and elderly, Total burden score, Community, Influencing factors

中图分类号:

R743

禚歆煜, 孙永安. 中老年人群脑小血管病总负荷的患病率及相关因素分析[J]. 华南预防医学, 2025, 51(12): 1287-1292.

ZHUO Xinyu, SUN Yong'an. Prevalence and correlates of the total burden of cerebral small vessel disease in a middle-aged and elderly community-based population[J]. South China Journal of Preventive Medicine, 2025, 51(12): 1287-1292.

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