| Objective: The clinical features and risk factors of Subcortical arteriosclerotic encephalopathy(SAE)were studied in order to provide the rationale and experimental data for the clinical application.Methods: The 93 patients who suffered from SAE were studied in our hospital from December 2008 to December 2009 (SAE group). In accordance with the diagnosis standards brought by Bennett: (1) Cognitive impairment; (2) MRI examination of T2 weighted image can show increased signal of intensity on white matter on the two sides; (3)The patients should meet at least two requirements of the following:①Risk factors of cerebrovascular diseases or general vascular disease;②Focal damaged signs and symptoms of cerebrovascular diseases;③Signs and symptoms of deterioration of cerebral subcortex. The patients with hepatorenal diseases and malignant tumor were excluded. The patients in SAE group Aged from 47 to 88, mean age 69.76±9.67years, the ratio of males to females was 2.1:1, the percentage of male patients was 67.74%. According to Kinkel typing, there were high signal on antecornu or cornu posterious ventriculi lateralis or in the middle of the lateral cerebral ventricle in type 1(SAE-type 1, 37 patients); high signal on partial affections of double sides that confluent or unconfluent around lateral cerebral ventricle in type 2 (SAE-type 2, 39 patients); high signal around the ventricle changed like lunar halo, including paracele in type3 (SAE-type3 11patients); diffuse high signal intensity from most or the whole white matter involvement even edges in type4 (SAE-type4 6 patients). There were 20 cases in control group. All of them were healthy physical examination in the corresponding period, aged 55-71 years, average age 63.75±4.96 years, 14 males and 6 females. Comparatively analyzed the common data (including gender, age, blood pressure, past medical history), clinical features, lab index (including blood total cholesterol, hemorheo1egy, plasma fibrinogen), and adopted enzyme linked immunosorbent assay (sandwich method of double antibody) to test the blood plasma homocysteine (Hcy). All data were analyzed using SPSS 13.0. The measurement data were analyzed through t-test or anova.The numeration data were analyzed by chi-square test. Spearman rank correlation was used to analyze the correlation.Result: 1 Common data: Compared the two groups for the gender, age, related medical history (hypertention, CHD, hyperlipidemia, hyperviscosity, diabetes and stroke) respectively, we could see that 63 of them were males (67.74%), 30 were females (32.26%), The ratio of males to females was 2.1:1, mean age of the two groups, SAE--type1 and SAE--type2 were 65.54±9.08 years and 70.05±9.31yeras respectively. There was statistic difference compared with SAE-type3 (mean age 77.55±6.09 years) and SAE--type 4(mean age 79.67±3.20 years) (P<0.05). About the four subgroups in SAE with stroke history, 23 patients belonged to type 1 (62.16%), 36 patients belonged to type 2 (92.31%), 11 patients belonged to type 3 (100%), 6 patients belonged to type 4 (100%). There was statistic difference between groups (P<0.05), which showed that the severity of SAE may closely related to the age and past medical history of stroke. For the other indexes the four subgroups in SAE had no statistic differences (P>0.05). The average age of the 20 cases in the control group was 63.75±4.96, no past stroke history, 4 cases with hypertention (20.00%), 3 cases with hyperlipidemia (15.00%), 4 cases with hyperviscosity (20.00%), 2 cases with CHD history (10.00%), 2 cases with diabetes history (10.00%), compared with SAE group there was statistic differences (P<0.05), which indicated that hypertension, hyperlipidemia, hyperviscosity, past medical history of CHD, diabetes and stroke might be important risk factors of SAE.2 Clinical features : (1) It was started slowly and got worse gradually, the course of the disease had lasted from 2 months to 5 years . (2) Clinical manifestation showed different degrees of mental disorders, which could be evaluated by mini-mental state examination(MMSE), 56 patients were mild (20～26 scores), 28 patients moderate (11～18 scores), 9 patients severe (6～9 scores). There were 33 patients of dizziness, 25 patients unsteady gait, 23 patients hemiplegia, 22 patients indifference, 20 patients emotion incontinence, 14 patients supranuclear paralysis, 11 patients of incontinence ,5 patients of Parkinson disease. (3) patients were examined by MRI. The results showed that MRI of T2 weighted image/FLAIR sequence could show limited or increased signal of intensity on white matter on the two sides following different extend of encephalatrophy. According to Kinkel typing: 37 patients belonged to type 1 (37.93%), 39 type 2 (41.94%),11 type3 (11.83%),6 type4 (6.45%). (4) The severity/MMSE evaluation scores of partial patients were not definitely parallel with Kinkel typing.3 Lab index: (1) Comparison of the whole blood viscosity(low), fibrinogen, average platelet aggregation between SAE groups and control group showed that there was no statistic difference among type1,2,3 groups for fibrinogen while there was statistic difference between these three groups and type4 group(P<0.05) . It indicated that the severity of SAE might be related to the increase of fibrinogen. For the other indexes the four subgroups in SAE had no statistic differences (P>0.05). For the above indexes, it showed statistic difference by comparing SAE group with control group (P<0.05), which meant that the whole blood viscosity, fibrinogen, average platelet aggregation might be risk factors of SAE. (2) SAE group CHOL 4.68±1.07 mmol/L,triglyceides 1.06±0.68 mmol/L,compared with the control group CHOL 4.12±0.86mmol/L,triglyceides 0.93±0.41mmol/L, the two groups had statistic differences (P<0.05) while there was no statistic differences among the subgroups. It showed that the blood fat might be a risk factor to SAE but had no correlation with the severity.4 Blood plasma Hcy Average blood plasma Hcy in SAE group was 14.60±4.23μmol/L, SAE--type1 group 13.73±3.73μmol/L, SAE--type2 group ( 14.45±4.52μmol/L ), SAE--type3 group ( 14.17±3.22μmol/L ),SAE--type4 group(21.73±1.52μmol/L), there was no statistic differences between SAE--1,2,3 subgroups while statistic differences could be seen compared with SAE--type4 group respectively (P<0.05). It meant that the severity of the disease might have correlation with the blood plasma Hcy. Comparing the average blood plasma Hcy in SAE group with the control group (10.04±2.09μmol/L), it showed statistic differences (P<0.05). It displayed that blood plasma Hcy might be a risk factor of SAE. There was no correlation detected between Hcy and other risk factors by Spearman correlation analysis (P>0.05). It meant that Hcy might be an independent risk factor of SAE.Conclusion: 1 SAE occured more at male, it was usually occult in onset and slowly progressed. Attack rate increased with the age.2 The severity may be associated with age, history of stroke, plasma fibrinogen and increased concentration of Hcy. There were not definitely paraleled between Symptoms(or MMSE)and changes of MRI in some patients.3 Hypertension, hyperlipidemia, hyperviscosity, hyperfibrinogenmia and Hyperhomocysfeinemia may be risk factors of SAE, stroke history, diabetes and CHD were important factors to affect SAE.4 Hyperhomocysfeinemia may be the independent risk factor of SAE.5 It will be of great value to treat risk factors and to prevent deteriorate in SAE.
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