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目的:探讨血清过氧化物酶体增殖物激活受体γ辅助活化活子-1α（peroxisome proliferator-activated receptor-γ coactivator-1α, PGC-1α）与脑小血管病（cerebral small vessel disease, CSVD）患者脑微出血（cerebral microbleeds, CMBs）及其严重程度的相关性。方法:前瞻性连续纳入2022年8月至2023年8月在南通大学第二附属医院及通州区第八人民医院神经内科住院的CSVD患者。依据MRI检测结果将患者分为非CMBs组和CMBs组，后者进一步分为轻度CMBs组（1~2个）、中度CMBs组（3~10个）及重度CMBs组（>10个）。通过多变量 logistic回归分析确定CMBs的独立相关因素。采用多元线性回归分析确定血清PGC-1α与CMBs数量的相关性。 结果:共纳入158例CSVD患者，96例（60.8%）存在CMBs；其中，轻度CMBs 55例，中度CMBs 24例，重度CMBs 17例。CMBs组PGC-1α和白细胞计数显著低于非CMBs组，而年龄、血小板计数、甘油三酯、空腹血糖和糖化血红蛋白显著高于非CMBs组（ P均<0.05）。多变量 logistic回归分析显示，校正年龄、空腹血糖、白细胞计数等混杂变量后，PGC-1α为CSVD患者CMBs的独立保护因素（优势比0.588，95%置信区间0.415~0.833； P=0.003）。多元线性回归分析显示，血清PGC-1α与CMBs数量呈显著负相关（ β=-0.566， P<0.001）。 结论:血清PGC-1α与CSVD患者CMBs及其严重程度相关；血清PGC-1α越高，存在CMBs的可能性越低。

Objective:To investigate associations of serum peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α) with cerebral microbleeds (CMBs) and their severity in patients with cerebral small vessel disease (CSVD).Methods:Consecutive patients with CSVD admitted to the Department of Neurology, the Second Affiliated Hospital of Nantong University and the Eighth People's Hospital of Tongzhou District, Nantong from August 2022 to August 2023 were prospectively included. According to the MRI findings, patients were divided into non-CMB group and CMB group, with the latter further divided into mild CMB group (1-2), moderate CMB group (3-10), and severe CMB group (>10). Multivariate logistic regression analysis was used to identify the independent correlation factors of CMBs. Multiple linear regression analysis was used to identify the correlation between serum PGC-1α and the number of CMBs. Results:A total of 158 patients with CSVD were included, of which 96 (60.8%) had CMBs; among them, 55 patients had mild CMBs, 24 had moderate CMBs, and 17 had severe CMBs. The PGC-1α and white blood cell count in the CMB group were significantly lower than those in the non-CMB group, while age, platelet count, triglycerides, fasting blood glucose, and glycated hemoglobin were significantly higher than those in the non-CMB group (all P<0.05). Multivariate logistic regression analysis showed that after adjusting for the confounding variables such as age, fasting blood glucose, and white blood cell count, PGC-1α was an independent protective factor for CMBs in patients with CSVD (odds ratio 0.588, 95% confidence interval 0.415-0.833; P=0.003). Multiple linear regression analysis showed a significant negative correlation between serum PGC-1α and the number of CMBs ( β=-0.566, P<0.001). Conclusion:Serum PGC-1α is associated with CMBs and their severity in patients with CSVD; the higher the serum PGC-1α, the lower the likelihood of the presence of CMBs.