中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2010年
5期
485-489
,共5页
王贺波%齐亚超%吕佩源%赵宝华%郭宗成%王天俊%张和振%刘昌林%靳玮%李玲%赵大卫%王建华
王賀波%齊亞超%呂珮源%趙寶華%郭宗成%王天俊%張和振%劉昌林%靳瑋%李玲%趙大衛%王建華
왕하파%제아초%려패원%조보화%곽종성%왕천준%장화진%류창림%근위%리령%조대위%왕건화
皮质下缺血性脑血管病%临床特征%认知损害%危险因素
皮質下缺血性腦血管病%臨床特徵%認知損害%危險因素
피질하결혈성뇌혈관병%림상특정%인지손해%위험인소
Subcortical ischemic vascular disease%Clinical feature%Cognitive impairment%Risk factor
目的 观察皮质下缺血性脑血管病(SIVD)患者的临床特征,分析确定SIVD患者认知损害的危险因素.方法 根据Erkinjuntti提出的MRI诊断标准入选SIVD患者70例,根据神经心理学评估分为认知正常(NCI)组和血管性认知损害(VCI)组;详细记录其血管性危险因素、症状和体征,应用单因素和多因素Logistic逐步回归进行分析.结果 多数(81.4%)患者表现为肢体肌力减退,其次为步态不稳和构音障碍(分别为40.0%、20.0%),但症状较轻;饮水呛咳和尿失禁各占14.3%.50例(71.4%)患者可检出上运动神经元受损体征;假性延髓麻痹和锥体外系体征者分别为10例、7例( 14.3%、10.0%),共济失调步态异常者仅5例(7.1%).NCI组和VCI组患者在年龄、性别和受教育年限方面差异无统计学意义(P>0.05);VCI组患者高血压、糖尿病和高脂血症的发生率明显高于NCI组(P<0.05),贫血、饮酒和吸烟史在两组之间差异无统计学意义(P>0.05).非条件Logistic逐步回归分析仅证实有高血压、糖尿病的SIVD患者更易出现认知损害(P<0.05),其OR值分别为5.265(1.563,17.731),3.445(1.008,11.772),高脂血症[OR 3.649(0.974,11.466);P=0.027]对SIVD患者出现认知损害所起的作用尚不能明确.结论 年龄可能并不是SIVD认知损害的危险因素;SIVD认知损害的危险因素可能为高血压、糖尿病,而高脂血症与SIVD认知损害的关系尚不确定.
目的 觀察皮質下缺血性腦血管病(SIVD)患者的臨床特徵,分析確定SIVD患者認知損害的危險因素.方法 根據Erkinjuntti提齣的MRI診斷標準入選SIVD患者70例,根據神經心理學評估分為認知正常(NCI)組和血管性認知損害(VCI)組;詳細記錄其血管性危險因素、癥狀和體徵,應用單因素和多因素Logistic逐步迴歸進行分析.結果 多數(81.4%)患者錶現為肢體肌力減退,其次為步態不穩和構音障礙(分彆為40.0%、20.0%),但癥狀較輕;飲水嗆咳和尿失禁各佔14.3%.50例(71.4%)患者可檢齣上運動神經元受損體徵;假性延髓痳痺和錐體外繫體徵者分彆為10例、7例( 14.3%、10.0%),共濟失調步態異常者僅5例(7.1%).NCI組和VCI組患者在年齡、性彆和受教育年限方麵差異無統計學意義(P>0.05);VCI組患者高血壓、糖尿病和高脂血癥的髮生率明顯高于NCI組(P<0.05),貧血、飲酒和吸煙史在兩組之間差異無統計學意義(P>0.05).非條件Logistic逐步迴歸分析僅證實有高血壓、糖尿病的SIVD患者更易齣現認知損害(P<0.05),其OR值分彆為5.265(1.563,17.731),3.445(1.008,11.772),高脂血癥[OR 3.649(0.974,11.466);P=0.027]對SIVD患者齣現認知損害所起的作用尚不能明確.結論 年齡可能併不是SIVD認知損害的危險因素;SIVD認知損害的危險因素可能為高血壓、糖尿病,而高脂血癥與SIVD認知損害的關繫尚不確定.
목적 관찰피질하결혈성뇌혈관병(SIVD)환자적림상특정,분석학정SIVD환자인지손해적위험인소.방법 근거Erkinjuntti제출적MRI진단표준입선SIVD환자70례,근거신경심이학평고분위인지정상(NCI)조화혈관성인지손해(VCI)조;상세기록기혈관성위험인소、증상화체정,응용단인소화다인소Logistic축보회귀진행분석.결과 다수(81.4%)환자표현위지체기력감퇴,기차위보태불은화구음장애(분별위40.0%、20.0%),단증상교경;음수창해화뇨실금각점14.3%.50례(71.4%)환자가검출상운동신경원수손체정;가성연수마비화추체외계체정자분별위10례、7례( 14.3%、10.0%),공제실조보태이상자부5례(7.1%).NCI조화VCI조환자재년령、성별화수교육년한방면차이무통계학의의(P>0.05);VCI조환자고혈압、당뇨병화고지혈증적발생솔명현고우NCI조(P<0.05),빈혈、음주화흡연사재량조지간차이무통계학의의(P>0.05).비조건Logistic축보회귀분석부증실유고혈압、당뇨병적SIVD환자경역출현인지손해(P<0.05),기OR치분별위5.265(1.563,17.731),3.445(1.008,11.772),고지혈증[OR 3.649(0.974,11.466);P=0.027]대SIVD환자출현인지손해소기적작용상불능명학.결론 년령가능병불시SIVD인지손해적위험인소;SIVD인지손해적위험인소가능위고혈압、당뇨병,이고지혈증여SIVD인지손해적관계상불학정.
Objective To investigate the clinical feature of subcortical ischemic cerebrovascular disease (SIVD) and the risk factor of its cognitive impairment.Methods Seventy SIVD patients,enrolled according to MRI diagnosis criteria proposed by Erkinjuntti,were divided,based on neuropsychological assessment,into groups NC (with normal cognition) and VCI (with vascular cognitive impairment).Vascular risk factors,symptoms and signs were recorded and analyzed by Logistic univariate- and multi-factor stepwise regression.Results Most patients presented with limb weakness (81 . 4%),followed by unsteady gait and dysarthria (40 . 0%,20 . 0%,respectively),but the symptoms were relatively mild.Drinking cough and urinary incontinence accounted for 14.3%,respectively.Upper motor neurom damage signs were detected in 50 patients (71.4%),pseudo-bulbar palsy and extrapyramidal symptoms in 10 and 7,respectively 14.3% and 10.0%,ataxia gait in 5 (7.1%).There was not significant difference in age,gender,year of education between groups NC and VCI (P>0.05).The incidences of hypertension,diabetes,coronary heart disease and hyperlipidemia were significantly higher in VCI group than in NC group (P<0.05).No significant difference was noted in anemia,alcohol consumption and smoking history between 2 groups (P>0.05).Non-conditional Logistic regression analysis confirmed that SIVD patients with hypertension and diabetes were more likely to present with cognitive damage,OR value=5.265(1.563,17.731),3.445(1.008,11.772),respectively,and the role of hyperlipidemia[OR=3.649(0.974,11.466);P=0.027]in cognitive damage was not clear.Conclusion It is likely that age is not correlated with cognitive impairment in SIVD patients.Hypertension and diabetes mellitus are the main risk factors of SIVD cognitive impairment,but the relationship between hyperlipidemia and cognitive impairment is still unclear.
