The Correlation Between White Matter Hyperintensity And Urinary Dysfunction In Patients With Cerebral Small Vessel Disease

BackgroudThe imaging signs of cerebral small vessel disease（CSVD）mainly include white matter hyperintensity（WMH）,lacunae of presumed vascular origin and cerebral microbleeds.WMH showed that the signal intensity of T1 sequence in white matter was equal or low signal,and that of T2 weighted and FLAIR sequence was high signal.Urinary dysfunction is common but easily ignored clinical manifestation of cerebral small vessel disease,The main manifestations are frequent urination,urgent urination,urinary incontinence and so on,which seriously affect the activity and quality of life of patients with CSVD,but there is no consensus on the relationship between dysuria and imaging markers of CSVD.Neurofilament light chain（NFL）is released into serum during central nervous system axonal injury and is a serum marker of white matter injury,which is expected to provide biological clues for the pathological factors of voiding disorders in patients with CSVD.ObjectiveTo evaluate the voiding function of patients with CSVH and to explore the correlation between the level of WMH and the degree of dysuria and the characteristics of WMH and the level of serum NFL.MethodsA total of 186 CSVD patients were enrolled in the Department of Neurology,the College from April 2019 to September 2021.Paraventricular and deep white matter lesions were scored separately by Fazekas scale,including deep white matter hyperintensities（DWMH）and periventricular white matter hyperintensities（PWMH）,and age-related white matter changes（age-related white matter changes,ARWMC）scale to evaluate the degree of WMH.The degree of WMH was evaluated by Fazekas scale and age related white matter（ARWMC）scale,and their voiding function was evaluated according to Over active Bladder Symptom Score（OABSS）.They were divided into Over active Bladder（OAB）group and non-OAB group.The level of NFL was detected by enzyme-linked immunosorbent assay（Elisa）,The correlation between dysuria and WMH characteristics and serum NFL level was analyzed.Results1.There were significant differences in diabetes,age,NFL,TC,Fazekas,DWMH,PWMH,ARWMC,frontal area,parietal-occipital and infratentorial scores between the two groups（P<0.05）.2.Multivariate Logistic analysis showed that age（OR=1.185,P<0.001）,diabetes（OR=2.954,P=0.011）,NFL（OR=1.223,P<0.001）,Fazekas total score（OR=4.190,P<0.001）,DWMH score（OR=21.187,P<0.001）,PWMH score（OR=5.338,P<0.001）,ARWMC total score（OR=3.125,P<0.001）,frontal lobe score（OR=154.077,P<0.001）,parietal-occipital lobe score（OR=7.114,P<0.001）were the risk factors of dysuria.There was no significant difference in TC and behind-the-scenes scores.3.The patients with dysuria were graded according to OABSS score,including 17 patients with mild OAB,14 patients with moderate OAB and 7 patients with severe OAB.Compared with the levels of WMH and NFL,there were significant differences in Fazekas scores between the two groups（P<0.05）.There were significant differences in the scores of DWMH and PWMH,among which the scores of patients with severe dysuria were higher than those of mild ones.There was no significant difference in the total scores of NFL,ARWMC,frontal lobe,parietal-occipital lobe,temporal lobe,infratentorial lobe and basal ganglia（P>0.05）.4.Spearman correlation analysis was performed on NFL level,WMH severity,ARWMC index and OABSS score in patients with urination disorder.The results showed that NFL level（r=0.521,P=0.001）,Fazekas score（r=0.507,P=0.001）,DWMH score（r=0.442,P=0.005）,PWMH score（r=0.440,P=0.006）,ARWMC score（r=0.381,P=0.018）,parietal-occipital lobe score（r=0.538,P<0.001）were positively correlated with OABSS score.ConclusionWMH is a risk factor for voiding disorders,which may be related to the occurrence of voiding disorders;the degree of WMH is positively correlated with the severity of voiding disorders,the higher the WMH score,the more severe the voiding disorders;the severity of voiding disorders is positively correlated with the serum NFL levels,and the more serious the voiding disorders,the higher the serum NFL levels.