踝臂指数与缺血性脑白质病变患者认知功能损害的关系研究

摘要

目的：探讨踝臂指数（ABI）与缺血性脑白质病变（IWML）患者认知功能损害的关系。方法选取于2013年1月—2014年6月到安徽医科大学附属宿州市立医院就诊的 IWML 患者80例。根据蒙特利尔认知评估（MoCA）量表的评估结果，将其分为认知正常组（n =30）和认知功能损害组（n =50）。比较并分析两组患者的临床资料，绘制 ABI 对 IWML 患者认知功能损害预测价值的受试者工作特征（ROC）曲线。结果两组平均年龄和 ABI 比较，差异有统计学意义（P <0.05）；两组性别、平均受教育年限、吸烟情况及合并高血压、糖尿病、血脂异常情况比较，差异无统计学意义（P >0.05）。二分类 Logistic 回归分析显示，ABI 对 IWML 患者认知功能损害的影响有统计学意义（P <0.05）。Pearson 相关分析显示，ABI 与 IWML 患者的 MoCA 评分存在正相关关系（ r =0.70，P <0.05）。ABI对 IWML 患者认知功能损害预测价值的 ROC 曲线下面积为（0.72±0.06）〔95% CI（0.60，0.84），P <0.01〕。当 ABI取值为0.81~0.90时，灵敏度为84.0%，特异度为53.3%，总准确度为72.5%。结论 ABI 是 IWML 患者认知功能损害的影响因素，与患者认知功能损害程度存在正相关关系，对 IWML 患者认知功能损害具有一定预测价值。%Objective To explore the association between ankle brachial index(ABI)and cognitive impairment in patients with ischemic white matter lesions( IWML). Methods A total of 80 IWML patients who received treatment in the department of neurology of Suzhou Municipal Hospital Affiliated to Anhui Medical University from January 2013 to June 2014 were enrolled. According to the assessment results of MoCA scale,the patients were divided into two groups:normal cognition group (n = 30)and impaired cognition group( n = 50). Comparison was made between the two groups in clinical data,and ROC curves of the value of ABI in the prediction of impaired cognition were made. Results The two groups were significantly different in average age and ABI( P < 0. 05);the two groups were not significantly different in gender,average education years, smoking status and the complication status of hypertension,diabetes and dyslipidemia(P > 0. 05). Binary logistic regression analysis showed that ABI had significant influence on cognitive impairment(P < 0. 05). Pearson correlation analysis showed that ABI had positive correlation with MoCA score of IWML patients( r = 0. 70,P < 0. 05). AUC of the value of ABI in the prediction of cognitive impairment of IWML patients was(0. 72 ± 0. 06)〔95% CI(0. 60,0. 84),P < 0. 01〕. When ABI was 0. 81 ~ 0. 90,the sensitivity and specificity were 84. 0% and 53. 3% ,with a total accuracy of 72. 5% . Conclusion ABI is an influencing factor for cognitive impairment of IWML patients and has positive correlation with cognitive impairment degree. ABI has predictive value for the cognitive impairment of IWML patients.