中华脑科疾病与康复杂志（电子版）
中華腦科疾病與康複雜誌（電子版）
중화뇌과질병여강복잡지（전자판）
CHINESE JOURNAL OF BRAIN DI8SEASES AND REHABILITATIN(ELECTRONIC EDITION)
2014年
4期
233-238
,共6页
脑小血管病%脑梗死%认知障碍
腦小血管病%腦梗死%認知障礙
뇌소혈관병%뇌경사%인지장애
Cerebral small vessel disease%Cerebral infarction%Cognitive impairment
目的：分析伴有脑小血管病（ CSVD ）的首次脑梗死患者在认知功能障碍方面的相关危险因素。方法选取2012年8月至2014年1月因急性脑梗死入住南通市第一人民医院神经内科的患者105例，并根据MRI 筛选出存在CSVD的患者41例，不伴有CSVD的患者64例，并对患者的年龄、性别、受教育程度、危险因素等人口统计学指标及临床特征进行评估，寻找CSVD的危险因素，将入选的所有患者采用蒙特利尔认知评估量表（ MoCA ）筛选出存在血管性认知功能障碍（ VCI ）的患者49例，其余56例无认知功能障碍，并比较两组的人口统计学特征，分析认知功能障碍的相关危险因素。采用Logistic 回归分析，Spearman等级相关分析等方法研究CSVD与认知功能障碍的相关性。结果在CSVD组与无CSVD组的比较中，高血压患者分别为34例（82.9％）和29例（45.3％，χ2＝14.732，P＝0.000），高脂血症患者为36例（87.8％）和25例（39.1％，χ2＝24.834，P＝0.000），冠心病患者为37例（90.2％）和28例（43.8％，χ2＝24.920，P＝0.000），差异均有统计学意义；CSVD组年龄[（73.13±4.96）岁]大于无CSVD组[（68.45±7.05）岁，t＝4.374，P＝0.015]；CSVD组和无CSVD组的MoCA评分分别为（23.50±2.102）分和（27.46±1.823）分，差异有统计学意义（ t＝7.207， P ＝0.000）；CSVD组在注意力评分[（3.09±0.916）分]、视空间和执行能力评分[（3.46±0.163）分]低于无 CSVD组（t＝5.384、11.546，P均＜0.05）。糖尿病患者分别为20例（48.7％）和34例（53.1％），差异无统计学意义（χ2＝0.003，P＝0.960）。认知功能障碍组年龄[（70.86±6.43）岁]大于无认知功能障碍组[（65.03±5.29）岁，t ＝7.651，P＝0.010]；认知功能障碍组平均受教育年限[（4.32±1.326）年]小于认知功能障碍组[（6.19±2.478）年，t＝7.850，P＝0.000]；认知功能障碍组及无认知功能障碍组皮质下关键部位受累分别为33例（71.7％）与26例（46.4％，χ2＝4.645，P＝0.048）。认知功能障碍组脑梗死体积为（6.461±1.385）mm3，无认知功能障碍组脑梗死体积为（6.280±1.472）mm3，两组差异无统计学意义（ t＝0.635，P＝0.587）。结论高血压、高脂血症、冠心病、年龄等是CSVD的危险因素。伴有CSVD的脑梗死患者更易出现认知功能障碍。 CSVD所累及的部位与认知功能障碍的程度密切相关。伴有CSVD 的血管性认知损害以注意和执行功能障碍为其主要特征。
目的：分析伴有腦小血管病（ CSVD ）的首次腦梗死患者在認知功能障礙方麵的相關危險因素。方法選取2012年8月至2014年1月因急性腦梗死入住南通市第一人民醫院神經內科的患者105例，併根據MRI 篩選齣存在CSVD的患者41例，不伴有CSVD的患者64例，併對患者的年齡、性彆、受教育程度、危險因素等人口統計學指標及臨床特徵進行評估，尋找CSVD的危險因素，將入選的所有患者採用矇特利爾認知評估量錶（ MoCA ）篩選齣存在血管性認知功能障礙（ VCI ）的患者49例，其餘56例無認知功能障礙，併比較兩組的人口統計學特徵，分析認知功能障礙的相關危險因素。採用Logistic 迴歸分析，Spearman等級相關分析等方法研究CSVD與認知功能障礙的相關性。結果在CSVD組與無CSVD組的比較中，高血壓患者分彆為34例（82.9％）和29例（45.3％，χ2＝14.732，P＝0.000），高脂血癥患者為36例（87.8％）和25例（39.1％，χ2＝24.834，P＝0.000），冠心病患者為37例（90.2％）和28例（43.8％，χ2＝24.920，P＝0.000），差異均有統計學意義；CSVD組年齡[（73.13±4.96）歲]大于無CSVD組[（68.45±7.05）歲，t＝4.374，P＝0.015]；CSVD組和無CSVD組的MoCA評分分彆為（23.50±2.102）分和（27.46±1.823）分，差異有統計學意義（ t＝7.207， P ＝0.000）；CSVD組在註意力評分[（3.09±0.916）分]、視空間和執行能力評分[（3.46±0.163）分]低于無 CSVD組（t＝5.384、11.546，P均＜0.05）。糖尿病患者分彆為20例（48.7％）和34例（53.1％），差異無統計學意義（χ2＝0.003，P＝0.960）。認知功能障礙組年齡[（70.86±6.43）歲]大于無認知功能障礙組[（65.03±5.29）歲，t ＝7.651，P＝0.010]；認知功能障礙組平均受教育年限[（4.32±1.326）年]小于認知功能障礙組[（6.19±2.478）年，t＝7.850，P＝0.000]；認知功能障礙組及無認知功能障礙組皮質下關鍵部位受纍分彆為33例（71.7％）與26例（46.4％，χ2＝4.645，P＝0.048）。認知功能障礙組腦梗死體積為（6.461±1.385）mm3，無認知功能障礙組腦梗死體積為（6.280±1.472）mm3，兩組差異無統計學意義（ t＝0.635，P＝0.587）。結論高血壓、高脂血癥、冠心病、年齡等是CSVD的危險因素。伴有CSVD的腦梗死患者更易齣現認知功能障礙。 CSVD所纍及的部位與認知功能障礙的程度密切相關。伴有CSVD 的血管性認知損害以註意和執行功能障礙為其主要特徵。
목적：분석반유뇌소혈관병（ CSVD ）적수차뇌경사환자재인지공능장애방면적상관위험인소。방법선취2012년8월지2014년1월인급성뇌경사입주남통시제일인민의원신경내과적환자105례，병근거MRI 사선출존재CSVD적환자41례，불반유CSVD적환자64례，병대환자적년령、성별、수교육정도、위험인소등인구통계학지표급림상특정진행평고，심조CSVD적위험인소，장입선적소유환자채용몽특리이인지평고량표（ MoCA ）사선출존재혈관성인지공능장애（ VCI ）적환자49례，기여56례무인지공능장애，병비교량조적인구통계학특정，분석인지공능장애적상관위험인소。채용Logistic 회귀분석，Spearman등급상관분석등방법연구CSVD여인지공능장애적상관성。결과재CSVD조여무CSVD조적비교중，고혈압환자분별위34례（82.9％）화29례（45.3％，χ2＝14.732，P＝0.000），고지혈증환자위36례（87.8％）화25례（39.1％，χ2＝24.834，P＝0.000），관심병환자위37례（90.2％）화28례（43.8％，χ2＝24.920，P＝0.000），차이균유통계학의의；CSVD조년령[（73.13±4.96）세]대우무CSVD조[（68.45±7.05）세，t＝4.374，P＝0.015]；CSVD조화무CSVD조적MoCA평분분별위（23.50±2.102）분화（27.46±1.823）분，차이유통계학의의（ t＝7.207， P ＝0.000）；CSVD조재주의력평분[（3.09±0.916）분]、시공간화집행능력평분[（3.46±0.163）분]저우무 CSVD조（t＝5.384、11.546，P균＜0.05）。당뇨병환자분별위20례（48.7％）화34례（53.1％），차이무통계학의의（χ2＝0.003，P＝0.960）。인지공능장애조년령[（70.86±6.43）세]대우무인지공능장애조[（65.03±5.29）세，t ＝7.651，P＝0.010]；인지공능장애조평균수교육년한[（4.32±1.326）년]소우인지공능장애조[（6.19±2.478）년，t＝7.850，P＝0.000]；인지공능장애조급무인지공능장애조피질하관건부위수루분별위33례（71.7％）여26례（46.4％，χ2＝4.645，P＝0.048）。인지공능장애조뇌경사체적위（6.461±1.385）mm3，무인지공능장애조뇌경사체적위（6.280±1.472）mm3，량조차이무통계학의의（ t＝0.635，P＝0.587）。결론고혈압、고지혈증、관심병、년령등시CSVD적위험인소。반유CSVD적뇌경사환자경역출현인지공능장애。 CSVD소루급적부위여인지공능장애적정도밀절상관。반유CSVD 적혈관성인지손해이주의화집행공능장애위기주요특정。
Objective To analyze the related risk factors in terms of cognitive dysfunction for the patients with cerebral infarction associated with cerebral small vessel disease .Methods One hundred and five patients in Neurology Department of Nantong First Peoples′Hospital with acute cerebral infarction from August 2012 to January 2014 were selected .According to MRI , 41 patients were associated with cerebral small vessel disease ( CSVD ) , and the other 64 patients were not associated with CSVD .The demographic indicators,such as the patient′s age,gender,education level,existing risk factors and clinical features were evaluated,looking for risk factors for CSVD.By using Montreal cognitive assessment (MoCA),49 patients were screened out with vascular cognitive impairment (VCI)from all the selected patients,the remaining 56 patients without cognitive dysfunction .The demographic characteristics of the two groups were compared to analyzerelated risk factors of cognitive dysfunction .The correlation between CSVD and cognitive dysfunction were studied by using the logistic regression and Spearman rank correlation analysis .Resulst Compared the group with CSVD and the group without CSVD ,the proportion of hypertension was34 cases (82.9%) and 29 cases(45.3%,χ2=14.732 ,P=0.000),the proportion of high cholesterol was 36 cases(87.8%) and 25 cases (39.1%,χ2 =24.834,P=0.000),the proportion of coronary heart disease was 37cases(90.2%)and 28 cases(43.8%,χ2=24.920,P=0.000);The age of CSVD group [(73.13 ±4.96)years] is greater than that of group without CSVD [ ( 68.45 ±7.05 ) years ,t=4.374,P=0.015 ];MoCA scores of groups with and without CSVD were ( 23.50 ±2.102 ) scores and( 27.46 ±1.823 ) scores;The attention function score [(3.09 ±0.916 )scores]and the visual spatial and executive ability score [(3.46 ±0.163)scores ]of the group with CSVD were less than the group without CSVD (t=5.384 ,11.546 ,all P<0.05 ) .The proportion of diabetes was20 cases ( 48.7%) and 34 cases ( 53.1%,χ2 =0.003 , P =0.960 ) .The age of cognitive dysfunction group [ ( 70.86 ±6.43 ) years ] was greater than the group without cognitive dysfunction [(65.03 ±5.29)years,t =7.651,P=0.010];The average years of education of group without cognitive dysfunction group [(4.32 ±1.326)years] were less than the cognitive dysfunction group [(6.19 ±2.478) years,t=7.850,P=0.000];The proportion of involvement of subcortical key parts of cognitive dysfunction group and the group without cognitive dysfunction was 33 cases(71.7%)and 26 cases(46.4%,χ2 =4.645, P=0.048 ) .The difference between the infarct volume of cognitive dysfunction group [ ( 6.461 ±1.385 ) mm3]and that of group without cognitive dysfunction [(6.280 ±1.472)mm3,t=0.635,P=0.587 ]had no statistical significance.Conclusions Hypertension ,high cholesterol ,coronary heart disease,and age are risk factors of CSVD .The cerebral infarction patients associated with CSVD are more likely to show cognitive dysfunction .The parts involved by CSVD are closely related to the extent of cognitive dysfunction .The attention and executive dysfunctionin is the main feature of vascular cognitive impairment associated with CSVD.
