Correlation Of Erythrocyte Distribution Width And Serum Homocysteine Levels With Cerebral White Matter Lesions

Objective: White matter lesion(WML)is a common cerebrovascular disease(CSVD)with a chronic and progressive course.The mechanism of its pathogenesis is not yet clear,the main theories include cerebral ischemia and hypoperfusion,blood brain barrier destruction,endothelial dysfunction,oxidative stress and inflammatory response.Diagnosis and severity assessment are mainly based on cranial MRI and image-based visual assessment scales,and lack of specific serological markers.Recent studies have found that red blood cell distribution width(RDW)and homocysteine(Hcy)may be potential biomarkers of inflammatory response and oxidative stress in cerebrovascular diseases,and play an important role in promoting the process of atherosclerosis,and are independent risk factors for CSVD.The purpose of this study was to investigate the correlation between RDW or serum Hcy levels and WML.Methods: A total of 403 patients admitted to the Department of Neurology of Liaoning Provincial People’s Hospital from January 2019 to September 2020 were retrospectively collected.They were divided into control group and WML group according to the presence or absence of WML.Collect into a group of patients with general data,including age,gender,history of hypertension,diabetes history,history of stroke,coronary heart disease history,history of smoking,drinking,laboratory indexes including white blood cells,red blood cells,hemoglobin,red blood cell volume,RDW-CV,RDW-SD,mean corpuscular volume,mean corpuscular hemoglobin,mean corpuscular hemoglobin concentration,platelet count,blood routine parameters,such as;Four items of blood lipid;Hcy,folic acid,vitamin B12;Hb A1 c,etc.Head MRI was used for the diagnosis of WML,and Fazekas score was made according to WML imaging findings,and groups were divided according to different severity and different sites of WML.SPSS26.0 statistical software was used for data processing.To investigate the correlation between RDW or serum Hcy levels and WML.Results:(1)A total of 403 inpatients in the Department of Neurology were included in this study,and were divided into control group(n=92),mild group(n= 151)and moderate and severe group(n= 160)according to the Fezakas scale score.Multivariate Logistic regression analysis between the WML group and the control group showed that advanced age,previous history of stroke and high level of RDW-SD were independent risk factors for WML.Spearman correlation analysis showed that RDW-SD(r=0.464,P<0.001)and Hcy(r=0.224,P<0.001)was positively correlated with Fazekas score,and there was a positive correlation between RDW-SD and Hcy(r=0.133,P=0.008).(2)Analysis of risk factors for moderate to severe white matter lesions in different sites:there were statistically significant differences in age,hypertension,history of stroke,RBC,HB,HCT,MCH,MCHC,RDW-SD,RDW-CV,TG,Hcy,VBC and VIT B12 between no/mild group and moderate to severe group(P < 0.05).The comparison between no/mild and moderate severe PVWML group and no/mild and moderate severe DWML group was basically consistent with the total WML,the difference was that there was no statistically significant difference in MCH between no/mild and moderate and severe DWML groups(P>0.05).(3)Hcy(OR = 1.037,95%CI 1.077-1.068,P = 0.015)was still statistically significant only after adjusting for age,hypertension,and previous stroke history in multivariate logistic regression analysis,but after the inclusion of blood routine related factors,it was found that the history of stroke(P=0.103)and Hcy(P=0.165)were no longer independent risk factors for moderate to severe WML,only advanced age(OR = 1.098,95%CI 1.061-1.136,P < 0.001),hypertension(OR = 2.276,95%CI 1.273-4.069,P = 0.006),high level of RDW-SD(OR = 1.893,95%CI1.214-2.951,P = 0.005)and low level of MCH(OR = 0.341,95%CI 0.128-0.909,P =0.032)were independent risk factors for moderate to severe WML.In this study,independent risk factors for moderate and severe PVWML were the same as those for moderate and severe total WML;the independent risk factors for moderate to severe DWML were advanced age(OR = 1.072,95%CI 1.037-1.109,P < 0.001),hypertension(OR = 2.049,95%CI 1.091-3.845,P = 0.026),previous stroke history(OR = 2.552,95%CI 1.355-4.806,P = 0.004),and high level RDW-SD(OR = 1.746,95%CI1.097-2.779,P = 0.019).(4)The subject operating curve between RDW-SD and moderate and severe WML was 0.768(95%CI 0.721-0.814,P < 0.001),when Youden index was the highest,the best truncation value of RDW-SD was 41.80 f L,and the sensitivity and specificity of RDW-SD for the prediction of moderate and severe white matter lesions were 71.3% and 70.4%.Conclusion: There was a positive correlation between RDW and HCY in middle-aged and elderly people.Advanced age,hypertension and elevated RDW-SD level were independent risk factors for WML and moderate to severe WML(no matter total WML,PVWML or DWML),and high RDW-SD level had certain predictive value for WML and moderate to severe WML.