缺血性脑小血管病患者轻度认知障碍的危险因素和临床特征:回顾性病例系列研究
결혈성뇌소혈관병환자경도인지장애적위험인소화림상특정:회고성병례계렬연구
Risk factors and clinical features of mild cognitive impairment in patients with ischemic cerebral small vessel disease:a retrospective case series study
  • 万方数据
    国际脑血管病杂志 국제뇌혈관병잡지
    INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
    2012年 8期 564-569 ,共6页

    樊亚超%王海峰%王新%孔伟%邢成名

    번아초%왕해봉%왕신%공위%형성명

    卒中%脑梗死%脑血管障碍%脑白质疏松%认知障碍%神经心理学测验%危险因素 卒中%腦梗死%腦血管障礙%腦白質疏鬆%認知障礙%神經心理學測驗%危險因素
    졸중%뇌경사%뇌혈관장애%뇌백질소송%인지장애%신경심이학측험%위험인소
    Stroke%Brain Infarction%Cerebrovascular Disorders%Leukoaraiosis%Cognition Disorders%Neuropsychological Tests%Risk Factors
    目的 探讨缺血性脑小血管病(small vessel disease,SVD)患者轻度认知障碍(mild cognitive impairment,MCI)的危险因素和临床特征,为早期诊断和早期干预提供依据.方法 应用蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)筛查MCI,收集相关危险因素和其他临床资料,并进行其他神经心理学测试.根据MRI表现将SVD分为脑白质疏松(leukoaraiosis,LA)、腔隙性梗死(lacunar infarction,LI)和LA与LI并存(LA-LI)3种类型.结果 共纳入143例SVD患者,其中MCI组68例,非MCI组75例.单变量分析显示,MCI组年龄、性别构成比与非MCI组无显著差异,但MCI组受教育年限显著短于非MCI组,而高血压(69.11％对45.33％;x2=8.215,P=0.004)、糖尿病(57.35％对40.00％;x2=4.301,P=0.038)、高脂血症(48.53％对24.00％;x2 =9.352,P=0.002)、颈动脉粥样硬化(41.18％对21.33％；x2=6.592,P=0.010)和吸烟(32.35％对14.67％；x2=6.285,P=0.012)的构成比以及尿酸[(351.81±83.21)mmol/L对(323.03±80.43)mmol/L；t=2.102,P=0.037]和总胆固醇[(5.26±1.26) mmol/L对(4.56±1.23) mmol/L；=3.326,P=0.001]水平显著高于非MCI组.多变量logistic回归分析显示,高血压[优势比(odds ratio,OR)2.227,95％可信区间(confidence interval,CI)1.001 ～4.954;P =0.026]、糖尿病(OR 2.056,95％ CI 1.862～4.937；P=0.046)、高脂血症(OR 2.528,95％ CI 1.361 ～5.770;P=0.028)、颈动脉粥样硬化(OR 2.658,95％ CI 1.110 ～6.367; P=0.029)、吸烟(OR2.566,95％ CI1.017 ～6.474；P=0.046)和受教育年限(OR0.825,95％ CI 0.745～0.914；P=0.000)是SVD患者出现MCI的独立危险因素.MCI组MoCA总分[(18.44±5.60)分对(27.09±1.37)分；t=-12.422,P=0.000]以及视空间/执行能力[(2.65±1.39)分对(4.49±0.74)分；t=-9.762,P=0.000]、注意力[(4.48±1.70)分对(5.89±0.31)分；t=6.706,P=0.000]、语言[(1.69±0.80)分对(2.41 ±0.95)分；t=4.893,P=0.018]、抽象能力[(0.85±0.69)分对(1.71 ±0.53)分；t=-7.081,P=0.000]、延迟回忆[(1.29±1.01)分对(4.04±0.99)分；t=13.824,P=0.000]等亚项得分均显著低于非MCI组,而命名和定向力得分无显著差异.在MCI组中,LA-LI组MoCA总分[(17.04±6.15)分对(21.04±3.98)分；P＜0.05]以及视空间/执行功能[(1.68± 1.16)分对(3.24±1.13)分；P＜0.05]、注意力[(3.92±2.03)分对(5.19±0.87)分；P＜0.05]、延迟回忆[(1.35±1.01)分对(1.86±1.58)分；P＜0.05]等亚项得分显著低于U组；LA组MoCA总分[(18.18±5.31)分对(21.04±3.98)分；P＜0.05]以及视空间/执行功能[(2.56±1.78)分对(3.24±1.13)分；P＜0.05]、语言[(0.64±0.23)分对(1.24±0.83)分；P＜ 0.05]、延迟回忆[(0.69±0.58)分对(1.86±1.58)分；P＜0.01]等亚项得分显著低于LI组；LA-LI组视空间/执行功能评分显著低于LA组[(1.68±1.16)分对(2.56±1.78)分；P＜0.05]和LI组[(1.68±1.16)分对(3.24±1.13)分；P＜0.05].结论 高血压、糖尿病、高脂血症、颈动脉粥样硬化、吸烟和受教育水平较低是SVD患者MCI的独立危险因素.SVD后MCI的认知损害表现为包括视空间/执行功能、延迟回忆在内的多个认知域损害,不同类型脑小血管病之间的认知损害有所不同.
    목적 탐토결혈성뇌소혈관병(small vessel disease,SVD)환자경도인지장애(mild cognitive impairment,MCI)적위험인소화림상특정,위조기진단화조기간예제공의거.방법 응용몽특리이인지평고량표(Montreal Cognitive Assessment,MoCA)사사MCI,수집상관위험인소화기타림상자료,병진행기타신경심이학측시.근거MRI표현장SVD분위뇌백질소송(leukoaraiosis,LA)、강극성경사(lacunar infarction,LI)화LA여LI병존(LA-LI)3충류형.결과 공납입143례SVD환자,기중MCI조68례,비MCI조75례.단변량분석현시,MCI조년령、성별구성비여비MCI조무현저차이,단MCI조수교육년한현저단우비MCI조,이고혈압(69.11％대45.33％;x2=8.215,P=0.004)、당뇨병(57.35％대40.00％;x2=4.301,P=0.038)、고지혈증(48.53％대24.00％;x2 =9.352,P=0.002)、경동맥죽양경화(41.18％대21.33％；x2=6.592,P=0.010)화흡연(32.35％대14.67％；x2=6.285,P=0.012)적구성비이급뇨산[(351.81±83.21)mmol/L대(323.03±80.43)mmol/L；t=2.102,P=0.037]화총담고순[(5.26±1.26) mmol/L대(4.56±1.23) mmol/L；=3.326,P=0.001]수평현저고우비MCI조.다변량logistic회귀분석현시,고혈압[우세비(odds ratio,OR)2.227,95％가신구간(confidence interval,CI)1.001 ～4.954;P =0.026]、당뇨병(OR 2.056,95％ CI 1.862～4.937；P=0.046)、고지혈증(OR 2.528,95％ CI 1.361 ～5.770;P=0.028)、경동맥죽양경화(OR 2.658,95％ CI 1.110 ～6.367; P=0.029)、흡연(OR2.566,95％ CI1.017 ～6.474；P=0.046)화수교육년한(OR0.825,95％ CI 0.745～0.914；P=0.000)시SVD환자출현MCI적독립위험인소.MCI조MoCA총분[(18.44±5.60)분대(27.09±1.37)분；t=-12.422,P=0.000]이급시공간/집행능력[(2.65±1.39)분대(4.49±0.74)분；t=-9.762,P=0.000]、주의력[(4.48±1.70)분대(5.89±0.31)분；t=6.706,P=0.000]、어언[(1.69±0.80)분대(2.41 ±0.95)분；t=4.893,P=0.018]、추상능력[(0.85±0.69)분대(1.71 ±0.53)분；t=-7.081,P=0.000]、연지회억[(1.29±1.01)분대(4.04±0.99)분；t=13.824,P=0.000]등아항득분균현저저우비MCI조,이명명화정향력득분무현저차이.재MCI조중,LA-LI조MoCA총분[(17.04±6.15)분대(21.04±3.98)분；P＜0.05]이급시공간/집행공능[(1.68± 1.16)분대(3.24±1.13)분；P＜0.05]、주의력[(3.92±2.03)분대(5.19±0.87)분；P＜0.05]、연지회억[(1.35±1.01)분대(1.86±1.58)분；P＜0.05]등아항득분현저저우U조；LA조MoCA총분[(18.18±5.31)분대(21.04±3.98)분；P＜0.05]이급시공간/집행공능[(2.56±1.78)분대(3.24±1.13)분；P＜0.05]、어언[(0.64±0.23)분대(1.24±0.83)분；P＜ 0.05]、연지회억[(0.69±0.58)분대(1.86±1.58)분；P＜0.01]등아항득분현저저우LI조；LA-LI조시공간/집행공능평분현저저우LA조[(1.68±1.16)분대(2.56±1.78)분；P＜0.05]화LI조[(1.68±1.16)분대(3.24±1.13)분；P＜0.05].결론 고혈압、당뇨병、고지혈증、경동맥죽양경화、흡연화수교육수평교저시SVD환자MCI적독립위험인소.SVD후MCI적인지손해표현위포괄시공간/집행공능、연지회억재내적다개인지역손해,불동류형뇌소혈관병지간적인지손해유소불동.
    Objective To investigate the risk factors and clinical features of mild cognitive impairment (MCI) in patients with ischemic cerebral small vessel disease (SVD) for early diagnosis and prevention.Methods Montreal Cognitive Assessment Scale (MoCA) was used to screen MCI.The related risk factors and other clinical data were collected,and other neuropsychological tests were conducted.SVD was divided into leukoaraiosis (LA),lacunar infarction (LI),and LA + LI.Results A total of 143 patients with SVD were enrolled (68 in an MCI group,75 in a non-MCI group).Univariate analysis showed that there was no significant difference in the constituent ratio of age and gender between the MCI group and the non-MCI group,but the years of education in the MCI group was shorter than that in the non-MCI group,while the composition ratios of hypertension (69.11％ vs.45.33 ％;x2 =8.215,P =0.004),diabetes (57.35％ vs.40.00％;x2 =4.301,P =0.038),hyperlipidemia (48.53％ vs.24.00％ ; x2 =9.352,P =0.002),carotid atherosclerosis (41.18％ vs.21.33％ ;x2 =6.592,P =0.010),and smoking (32.35％ vs.14.67％ ;x2 =6.285,P =0.012),as well as the levels of uric acid (351.81 ± 83.21 mmol/L vs.323.03 ± 80.43 mmol/L; t =2.102,P =0.037) and total cholesterol (5.26 ± 1.26 mmol/L vs.4.56 ± 1.23 mmol/L; t =3.326,P =0.001) were significantly higher than those in the non-MCI group.Multivariate logistic regression analysis showed that hypertension (odds ratio OR]2.227,95％ confidence interval [CI],1.001-4.954; P =0.026),diabetes (OR 2.056,95％ CI 1.862-4.937; P =0.046),hyperlipidemia (OR 2.528,95％ CI 1.361-5.770; P =0.028),carotid atherosclerosis (OR 2.658,95％ CI 1.110-6.367; P =0.029),smoking (OR 2.566,95％ CI 1.017-6.474; P =0.046),and years of education (OR 0.825,95％ CI 0.745-0.914; P =0.000) were the independent risk factors for the occurrence of MCI in patients with SVD.The subscores in the MCI group,including MoCA total score (18.44 ± 5.60 vs.27.09 ± 1.37; t =-12.422; P =0.000),as well as visuoconstructional skills (2.65 ± 1.39 vs.4.49 ± 0.74; t =-9.762; P =0.000),attention (4.48 ± 1.70vs.5.89 ± 0.31; t =6.706,P=0.000),language (1.69 ± 0.80vs.2.41 ± 0.95 ; t =4.893,P=0.018),abstraction (0.85 ± 0.69 vs.1.71 ± 0.53; t=-7.081,P=0.000),delayed recall (1.29 ±1.01 vs.4.04 ± 0.99; t =13.824,P =0.000) were significantly lower than those in the non-MCI group,and there were no significant differences in naming and orientation scores.In the MCI group,the subscores such as theMoCA total score in the LA+LI group (17.04 ± 6.15 vs.21.04 ± 3.98; P＜0.05),as well as visuoconstructional skills (1.68 ± 1.16 vs.3.24 ± 1.13; P ＜ 0.05),attention (3.92 ± 2.03 vs.5.19 ±0.87; P ＜0.05),delayed recall (1.35 ± 1.01 vs.1.86 ± 1.58; P ＜0.05) were significantly lower than those in the LI group; the subscores such as the MoCA total score in the LA group (18.18 ± 5.31 vs.21.04 ± 3.98; ＜ =0.05),as well as visuoconstructional skills (2.56 ± 1.78 vs.3.24 ± 1.13; P＜0.05),language (0.64 ± 0.23 vs.1.24 ± 0.83; P ＜0.05),delayed recall (0.69 ± 0.58vs.1.86 ± 1.58;P＜0.01)were significantly lower than those in the LI group; the visuoconstructional skills in the LA + LI group was significantly lower than that in the LA group (1.68 ± 1.16 vs.2.56 ± 1.78; P＜0.05) and the LI group (1.68 ± 1.16 vs.3.24 ± 1.13; P＜ 0.05).Conclusions Hypertension,diabetes,hyperlipidemia,carotid atherosclerosis,smoking,and the low level of education were the independent risk factors for MCI in patients with SVD.After SVD,the cognitive impairment in MCI presented as multiple cognitive domains impairments,including visuoconstructional skills and delayed recall.Cognitive impairment differed among the different types of SVD.
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