CAJ | 학술논문

目的探讨小血管闭塞性卒中( small artery occlusion,SAO)患者认知功能损害与脑微出血(cerebral microbleed,CMB)的相关性.方法选择南京卒中注册系统2011年1月至2011年5月期间的SAO患者,应用蒙特利尔认知评价量表(Montreal Cognitive Assessment,MoCA)进行认知评价,同时行常规序列MRI以及磁敏感加权成像(susceptibility-weighted imaging,SWI)检测CMB.结果共纳入SAO患者70例,其中MoCA评分异常(＜26分)者48例,MoCA评分正常(≥26分)者22例.患者年龄(t=-2.237,P=0.023)、受教育年限(t=2.297,P=0.025)、高血压史(x2=2.297,P=0.029)、白质病变程度(Z=-3.263,P=0.001)和存在CMB(P=0.001)与SAO患者MoCA评分异常有关.Logistic回归分析表明,在校正年龄、性别、白质病变以及高血压、糖尿病和冠心病史后,存在CMB(优势比5.648,95％可信区间1.105 ～28.869;P =0.038)仍然是MoCA评分异常的独立危险因素.CMB程度越严重,MoCA评分越低(r=-0.532,P＜0.001).在CMB患者中,MoCA总分(t=5.180,P＜0.001)、视空间触行功能(t=3.924,P＜0.001)与注意力(t=4.309,P＜0.001)等认知领域显著受损,不同部位CMB可导致相关领域的认知功能损伤.结论 CMB数量和部位与SAO患者的认知功能损害密切相关.
목적 탐토소혈관폐새성졸중( small artery occlusion,SAO)환자인지공능손해여뇌미출혈(cerebral microbleed,CMB)적상관성.방법 선택남경졸중주책계통2011년1월지2011년5월기간적SAO환자,응용몽특리이인지평개량표(Montreal Cognitive Assessment,MoCA)진행인지평개,동시행상규서렬MRI이급자민감가권성상(susceptibility-weighted imaging,SWI)검측CMB.결과 공납입SAO환자70례,기중MoCA평분이상(＜26분)자48례,MoCA평분정상(≥26분)자22례.환자년령(t=-2.237,P=0.023)、수교육년한(t=2.297,P=0.025)、고혈압사(x2=2.297,P=0.029)、백질병변정도(Z=-3.263,P=0.001)화존재CMB(P=0.001)여SAO환자MoCA평분이상유관.Logistic회귀분석표명,재교정년령、성별、백질병변이급고혈압、당뇨병화관심병사후,존재CMB(우세비5.648,95％가신구간1.105 ～28.869;P =0.038)잉연시MoCA평분이상적독립위험인소.CMB정도월엄중,MoCA평분월저(r=-0.532,P＜0.001).재CMB환자중,MoCA총분(t=5.180,P＜0.001)、시공간촉행공능(t=3.924,P＜0.001)여주의력(t=4.309,P＜0.001)등인지영역현저수손,불동부위CMB가도치상관영역적인지공능손상.결론 CMB수량화부위여SAO환자적인지공능손해밀절상관.
Objective To investigate the correlation between cognitive function and cerebral microbleeds (CMBs) in patients with small artery occlusive stroke (SAO).Methods The patients with SAO in Nanjing Stroke Registration Program were recruited from January 2011 to May 2011.The Montreal Cognitive Assessment (MoCA) was used to conduct the cognitive evaluation.At the same time,conventional MRI sequences and susceptibility-weighted imaging (SWI) were used to detect CMBs.Results A total of 70 patients with SAO were included in the study,48 of them had abnormal MoCA scores ( ＜26 points) and 22 of them had normal MoCA scores (≥26).The age of patients (t =-2.237,P =0.023),years of education (t =2.297,P =0.029),history of hypertension (x2 =2.297,P =0.025 ),severity of white matter hyperintensities (Z =-3.263,P =0.001) and presence of CMBs (P =0.001) were associated with the abnormal MoCA scores in patients with SAO.Logistic regression analysis showed that after adjusting for age,sex,white matter lesions,hypertension,diabetes and coronary heart disease,the presence of CMBs (odds ratio 5.648,95％ confidence interval 1.105-28.869; P =0.038) was still an independent risk factor for abnormal MoCA scores.The more serious of CMBs,the lower the MoCA scores (r =- 0.532,P ＜ 0.001 ).In patients with CMBs,the cognitive domain,such as the total MoCA score (t =5.180,P ＜ 0.001 ),visuospatial/executive function (t =3.924,P ＜ 0.001 ) and attention (t =4.309,P ＜ 0.001 ) were impaired significantly.The CMBs at different parts resulted in cognitive impairment in the related fields.Conclusions The numbers of CMBs and their locations were closely associated with cognitive impairment in patients with SAO.