Department of Neurology, Maoming People's Hospital, Maoming, China.
Department of Radiology, Maoming People's Hospital, Maoming, China.
BMC Geriatr. 2023 Jun 21;23(1):382. doi: 10.1186/s12877-023-03991-2.
The pathogenesis and pathophysiology of idiopathic normal pressure hydrocephalus (iNPH) remain unclear. Homocysteine may reduce the compliance of intracranial arteries and damage the endothelial function of the blood-brain barrier (BBB), which may be the underlying mechanism of iNPH. The overlap cases between deep perforating arteriopathy (DPA) and iNPH were not rare for the shared risk factors. We aimed to investigate the relationship between serum homocysteine and iNPH in DPA.
A total of 41 DPA patients with iNPH and 49 DPA patients without iNPH were included. Demographic characteristics, vascular risk factors, laboratory results, and neuroimaging data were collected. Multivariable logistic regression analysis was performed to investigate the relationship between serum homocysteine and iNPH in DPA patients.
Patients with iNPH had significantly higher homocysteine levels than those without iNPH (median, 16.34 mmol/L versus 14.28 mmol/L; P = 0.002). There was no significant difference in CSVD burden scores between patients with iNPH and patients without iNPH. Univariate logistic regression analysis demonstrated that patients with homocysteine levels in the Tertile3 were more likely to have iNPH than those in the Tertile1 (OR, 4.929; 95% CI, 1.612-15.071; P = 0.005). The association remained significant after multivariable adjustment for potential confounders, including age, male, hypertension, diabetes mellitus, atherosclerotic cardiovascular disease (ASCVD) or hypercholesterolemia, and eGFR level.
Our study indicated that high serum homocysteine levels were independently associated with iNPH in DPA. However, further research is needed to determine the predictive value of homocysteine and to confirm the underlying mechanism between homocysteine and iNPH.
特发性正常压力脑积水（iNPH）的发病机制和病理生理学仍不清楚。同型半胱氨酸可能降低颅内动脉顺应性并损害血脑屏障（BBB）的内皮功能，这可能是 iNPH 的潜在机制。深穿通动脉病（DPA）和 iNPH 之间的重叠病例并不少见，因为它们有共同的危险因素。我们旨在研究 DPA 中血清同型半胱氨酸与 iNPH 之间的关系。
共纳入 41 例 DPA 合并 iNPH 患者和 49 例 DPA 不合并 iNPH 患者。收集人口统计学特征、血管危险因素、实验室结果和神经影像学数据。采用多变量逻辑回归分析探讨 DPA 患者血清同型半胱氨酸与 iNPH 的关系。
iNPH 患者的同型半胱氨酸水平明显高于无 iNPH 患者（中位数 16.34mmol/L 比 14.28mmol/L；P=0.002）。iNPH 患者和无 iNPH 患者的 CSVD 负荷评分无显著差异。单因素逻辑回归分析表明，同型半胱氨酸水平处于第 3 分位的患者比处于第 1 分位的患者更有可能患有 iNPH（OR，4.929；95%CI，1.612-15.071；P=0.005）。在校正了年龄、男性、高血压、糖尿病、动脉粥样硬化性心血管疾病（ASCVD）或高胆固醇血症和 eGFR 水平等潜在混杂因素后，这种关联仍然显著。
我们的研究表明，高血清同型半胱氨酸水平与 DPA 中的 iNPH 独立相关。然而，需要进一步研究来确定同型半胱氨酸的预测价值，并确认同型半胱氨酸与 iNPH 之间的潜在机制。
