Department of Neurology, Hematology, Metabolism, Endocrinology, and Diabetology, Faculty of Medicine, Yamagata University, Iida-Nishi, Yamagata, Japan.
Eur J Neurol. 2010 Mar;17(3):383-90. doi: 10.1111/j.1468-1331.2009.02809.x. Epub 2009 Oct 10.
Recent studies have shown that kidney dysfunction is associated with cerebral small vessel disease (SVD). Although creatinine-based estimating equations have been used as the standard measure for the evaluation of kidney function, the accuracy of these is limited in the elderly because of muscle mass decrease with aging. Cystatin C is a more useful measurement than creatinine-based estimating equations for evaluating kidney function, however, the relationship amongst cystatin C, cognitive dysfunction, and cerebral SVD has not been fully examined in community-based elderly.
We performed a cross-sectional study using MRI to determine the relationship amongst cystatin C, cognitive function, and cerebral SVD in a total of 604 community-based Japanese elderly.
In this study, subjects with higher cystatin C levels tended to have more lacunas and higher grades of white matter lesions. Although a decline of the Mini-Mental State Examination (MMSE) scores was associated with SVD-related lesions, the relationship between the tertiles of cystatin C and mean MMSE scores was not statistically significant. In the logistic regression analysis, the association between cystatin C and SVD-related lesions was statistically significant, even after adjustment for conventional risk factors and high-sensitivity C-reactive protein. Furthermore, subjects with higher cystatin C levels accompanied with albuminuria had a greater risk for the presence of subclinical cerebral SVD than those with lower cystatin C levels without albuminuria.
The present study suggests that there is a close relationship between cystatin C and subclinical cerebral SVD, independently of conventional risk factors, in community-based elderly.
最近的研究表明，肾功能障碍与脑小血管疾病（SVD）有关。虽然基于肌酐的估算方程已被用作评估肾功能的标准测量方法，但由于肌肉质量随年龄的减少，这些方法在老年人中的准确性有限。胱抑素 C 是一种比基于肌酐的估算方程更有用的测量方法，用于评估肾功能，然而，胱抑素 C、认知功能障碍和脑 SVD 之间的关系在社区老年人中尚未得到充分研究。
我们进行了一项横断面研究，使用 MRI 来确定 604 名社区日本老年人中胱抑素 C、认知功能和脑 SVD 之间的关系。
在这项研究中，胱抑素 C 水平较高的受试者往往有更多的腔隙和更高程度的白质病变。虽然 Mini-Mental State Examination（MMSE）评分下降与 SVD 相关病变有关，但胱抑素 C 三分位值与 MMSE 评分平均值之间的关系没有统计学意义。在逻辑回归分析中，即使在调整了传统危险因素和高敏 C 反应蛋白后，胱抑素 C 与 SVD 相关病变之间的关联仍然具有统计学意义。此外，伴有白蛋白尿的胱抑素 C 水平较高的受试者比胱抑素 C 水平较低且无白蛋白尿的受试者发生亚临床脑 SVD 的风险更大。
本研究表明，在社区老年人中，胱抑素 C 与亚临床脑 SVD 之间存在密切关系，独立于传统危险因素。
