不同类型脑小血管病患者认知功能损害特征及危险因素分析

摘要

Objective To investigate the characteristics and risk factors of cognitive dysfunction due to different types of cerebral small vascular disease(CSVD). Methods One hundred and eighteen patients who hospitalized in the Department of Neurology,the First Hospital of Hebei Medical University from 2012 to 2013,were selected. They were divided into 3 groups according to the manifestations of MRI:white matter lesion( WML)group(40 cases),lacunar infarction( LI)group(38 cases),WML + LI group(40 cases). Meanwhile,39 people who had normal MRI findings from the outpatient were selected as control group. We recorded and measured the patient′s gender,age,education years,as well as the medical history(smoking, drinking,hypertension,diabetes,hyperlipidemia,stroke)and the hs-CRP level,respectively. All cases were scored by Mini- Mental State Examination( MMSE),Montreal Cognitive Assessment( MoCA),and Clinical Dementia Rating( CDR). Furthermore,the risk factors for cognitive dysfunction in CSVD patients were evaluated by multivariate Logistic regression analysis. Results There were significantly statistical differences in the total score of MMSE and scores in the domains of memory,recall,attention and calculation among the four groups(P < 0. 05). Compared with the control group,WML group had lower total score of MMSE and scores in domains of memory and recall(P < 0. 05),LI group had lower total score of MMSE and scores in domain of recall( P < 0. 05). WML + LI group had lower total score of MMSE and scores in the domains of memory,recall,attention and calculation than other groups(P < 0. 05). In addition,the differences in total score of MoCA and scores in domains of visual space and executive function,memory,language and calculation among the four groups were statistically significant(P < 0. 05). Compared with the control group,the total score of MoCA,scores in the domains of visual space and executive function,memory,language were lower in the WML group(P < 0. 05),the total score of MoCA,scores in the domains of visual space and executive function,language were lower in the LI group( P < 0. 05). WML + LI group had lower total score of MoCA,lower scores in the domains of visual space and executive function,language and calculation compared with other groups(P < 0. 05),however,only the score in the memory were lower than LI group and control group(P< 0. 05). The degree of dementia was more severe in WML and LI groups than that in the control group(P < 0. 05);however, it was the most severe in the WML + LI group(P < 0. 05). Results of multivariate Logistic regression analysis showed that longer years of education was a protect factor〔OR = 0. 684,95% CI(0. 561,0. 835)〕,while advanced age〔OR = 1. 092,95% CI (1. 022,1. 168 )〕,smoking〔 OR = 3. 732,95% CI( 1. 058,13. 164 )〕,drinking〔 OR = 4. 615,95% CI ( 1. 094, 19. 465)〕,diabetes〔OR = 2. 937,95% CI(1. 016,8. 491)〕,hyperlipidemia〔OR = 3. 207,95% CI(1. 024,10. 045)〕and high level of hs-CRP〔OR = 1. 245,95% CI(1. 040,1. 492)〕were risk factors for cognitive dysfunction in CSVD patients (P < 0. 05). Conclusion The characteristics of cognitive dysfunction are different in various types of CSVD,the differences mainly showed in domains of visual space and executive function,memory,language and calculation cognitive,furthermore, WML combined with LI will aggravate cognitive impairment and dementia. Advanced age, smoking, drinking, diabetes, hyperlipidemia and high level of hs-CRP are risk factors of cognitive dysfunction in CSVD patients.%目的：比较不同类型脑小血管病（CSVD）患者认知功能损害的特征，并分析其危险因素。方法选取2012—2013年河北医科大学第一医院神经内科住院治疗的 CSVD 患者118例，根据影像学表现，分为脑白质病变（WML）组40例，腔隙性脑梗死（LI）组38例，WML + LI 组40例。另选取同期门诊就诊影像学无异常者39例为对照组。记录受试者性别、年龄、受教育年限、吸烟史、饮酒史，是否合并高血压、糖尿病、高脂血症，有无脑卒中病史，以及超敏 C 反应蛋白（hs-CRP）水平。采用简易智力状态检查量表（MMSE）及蒙特利尔认知评估量表（MoCA）评估受试者认知能力，采用临床痴呆评定量表（CDR）评估受试者痴呆严重程度。应用多因素 Logistic 回归分析 CSVD患者发生认知功能损害的危险因素。结果各组 MMSE 总分及记忆力、回忆能力、注意和计算力评分比较，差异有统计学意义（P <0.05）；其中，WML 组 MMSE 总分及记忆力、回忆能力评分低于对照组，LI 组 MMSE 总分及回忆能力评分低于对照组，WML + LI 组 MMSE 总分及记忆力、回忆能力、注意和计算力评分低于对照组、WML 组、LI 组（P <0.05）。各组 MoCA 总分、视空间及执行功能、记忆、语言、计算评分比较，差异有统计学意义（ P <0.05）；其中， WML 组 MoCA 总分、视空间及执行功能、记忆、语言评分低于对照组，LI 组 MoCA 总分、视空间及执行功能、语言评分低于对照组，WML + LI 组 MoCA 总分、视空间及执行功能、语言、计算评分低于对照组、WML 组、LI 组，记忆评分低于对照组、LI 组（P <0.05）。WML 组、LI 组痴呆程度较对照组严重，WML + LI 组痴呆程度较对照组、WML 组、LI 组严重（P <0.05）。多因素 Logistic 回归分析显示，较高的受教育年限〔OR =0.684，95% CI（0.561，0.835）〕是CSVD 患者认知功能损害的保护因素，高龄〔 OR =1.092，95% CI（1.022，1.168）〕、吸烟史〔 OR =3.732，95% CI （1.058，13.164）〕、饮酒史〔 OR =4.615，95% CI（1.094，19.465）〕、糖尿病〔 OR =2.937，95% CI（1.016，8.491）〕、高脂血症〔 OR =3.207，95% CI（1.024，10.045）〕及hs-CRP水平升高〔 OR =1.245，95% CI（1.040，1.492）〕是 CSVD 患者认知功能损害的危险因素（ P <0.05）。结论不同类型 CSVD 患者均可产生认知功能损害， WML 合并 LI 患者认知功能损害更为严重，主要表现为视空间及执行功能、记忆、语言、计算4个认知域损害，且WML 合并 LI 可加重痴呆的发生；高龄、吸烟史、饮酒史、糖尿病、高脂血症及hs-CRP水平升高是 CSVD 患者发生认知功能损害的危险因素。