国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2014年
2期
105-110
,共6页
张永红%王海峰%王新%张莉%邢成名
張永紅%王海峰%王新%張莉%邢成名
장영홍%왕해봉%왕신%장리%형성명
卒中%腔隙%脑白质病%认知障碍%磁共振成像%危险因素
卒中%腔隙%腦白質病%認知障礙%磁共振成像%危險因素
졸중%강극%뇌백질병%인지장애%자공진성상%위험인소
Stroke,Lacunar%Leukoencephalopathies%Cognition Disorders%Magnetic Resonance Imaging%Risk Factors
目的 探讨腔隙性梗死(lacunar infarct,LI)和脑白质病变(white matter lesion,WML)患者认知损害的特征及其危险因素.方法 纳入年龄65 ～ 75岁的LI和WML住院患者,收集其人口统计学和临床资料.LI和WML通过MRI确诊.采用蒙特利尔认知评估量表(Montreal Cognitive Assessment,MoCA)评价认知功能.采用抑郁自评量表和汉密尔顿焦虑量表排除抑郁和焦虑患者.根据MoCA总分将患者分为认知损害组和认知功能正常组,比较两组人口统计学和临床资料.采用多变量logistic回归分析确定认知损害的独立危险因素.对LI和WML的认知损害特征进行比较.结果 共纳入130例LI或WML患者.其中,92例存在认知损害,38例认知功能正常;85例存在LI,45例存在WML;男性53例,女性77例.单变量分析显示,认知损害组受教育年限[(7.54±4.65)年对(11.29±3.17)年;t=4.286,P=0.001]显著性低于认知正常组,而高血压(54.6％对16.2％;x2=4.477,P=0.018)、高脂血症(53.1％对16.2％;x2=5.263,P =0.044)、糖尿病(46.9％对10.8％;x2=3.827,P=0.017)以及LI(43.8％对21.5％;x2=3.928,P=0.015)和WML(26.9％对7.7％;x2=4.072,P=0.009)的构成比显著性高于认知正常组.多变量logistic回归分析显示,受教育年限[优势比(odds ratio,OR)1.305,95％可信区间(confidence interval,CI)1.104 ～7.975;P=0.001]、糖尿病(OR 1.328,95％ CI 1.292～3.422;P=0.015)、高血压(OR1.978,95％CI1.034～5.443;P=0.028)、LI(OR 1.224,95％ CI1.004 ～2.007;P=0.013)和WML(OR 1.489,95％ CI 1.202～3.778;P=0.010)是认知损害的独立危险因素.WML组MoCA总分[(21.61±5.33)分对(19.19±7.07)分;t=1.841,P=0.038]以及立方体复制[(0.43±0.50)分对(0.31 ±0.47)分;t=1.104,P=0.010]、画钟实验[(2.53 ±0.89)分对(2.04±1.22)分;t=2.229,P=0.008]、字母辨别[(0.85±0.36)分对(0.62±0.50)分;t=2.585 P=0.000]和100连续减7[(2.62±0.79)分对(2.19±1.17)分;=2.113;P=0.001]得分均显著性低于LI组.结论 LI和WML患者均常伴有认知损害,而且WML患者的认知损害较重.受教育年限、高血压病和糖尿病是LI和WML患者发生认知损害的独立危险因素.WML患者的视空间执行功能和注意力损害较LI患者更明显.
目的 探討腔隙性梗死(lacunar infarct,LI)和腦白質病變(white matter lesion,WML)患者認知損害的特徵及其危險因素.方法 納入年齡65 ～ 75歲的LI和WML住院患者,收集其人口統計學和臨床資料.LI和WML通過MRI確診.採用矇特利爾認知評估量錶(Montreal Cognitive Assessment,MoCA)評價認知功能.採用抑鬱自評量錶和漢密爾頓焦慮量錶排除抑鬱和焦慮患者.根據MoCA總分將患者分為認知損害組和認知功能正常組,比較兩組人口統計學和臨床資料.採用多變量logistic迴歸分析確定認知損害的獨立危險因素.對LI和WML的認知損害特徵進行比較.結果 共納入130例LI或WML患者.其中,92例存在認知損害,38例認知功能正常;85例存在LI,45例存在WML;男性53例,女性77例.單變量分析顯示,認知損害組受教育年限[(7.54±4.65)年對(11.29±3.17)年;t=4.286,P=0.001]顯著性低于認知正常組,而高血壓(54.6％對16.2％;x2=4.477,P=0.018)、高脂血癥(53.1％對16.2％;x2=5.263,P =0.044)、糖尿病(46.9％對10.8％;x2=3.827,P=0.017)以及LI(43.8％對21.5％;x2=3.928,P=0.015)和WML(26.9％對7.7％;x2=4.072,P=0.009)的構成比顯著性高于認知正常組.多變量logistic迴歸分析顯示,受教育年限[優勢比(odds ratio,OR)1.305,95％可信區間(confidence interval,CI)1.104 ～7.975;P=0.001]、糖尿病(OR 1.328,95％ CI 1.292～3.422;P=0.015)、高血壓(OR1.978,95％CI1.034～5.443;P=0.028)、LI(OR 1.224,95％ CI1.004 ～2.007;P=0.013)和WML(OR 1.489,95％ CI 1.202～3.778;P=0.010)是認知損害的獨立危險因素.WML組MoCA總分[(21.61±5.33)分對(19.19±7.07)分;t=1.841,P=0.038]以及立方體複製[(0.43±0.50)分對(0.31 ±0.47)分;t=1.104,P=0.010]、畫鐘實驗[(2.53 ±0.89)分對(2.04±1.22)分;t=2.229,P=0.008]、字母辨彆[(0.85±0.36)分對(0.62±0.50)分;t=2.585 P=0.000]和100連續減7[(2.62±0.79)分對(2.19±1.17)分;=2.113;P=0.001]得分均顯著性低于LI組.結論 LI和WML患者均常伴有認知損害,而且WML患者的認知損害較重.受教育年限、高血壓病和糖尿病是LI和WML患者髮生認知損害的獨立危險因素.WML患者的視空間執行功能和註意力損害較LI患者更明顯.
목적 탐토강극성경사(lacunar infarct,LI)화뇌백질병변(white matter lesion,WML)환자인지손해적특정급기위험인소.방법 납입년령65 ～ 75세적LI화WML주원환자,수집기인구통계학화림상자료.LI화WML통과MRI학진.채용몽특리이인지평고량표(Montreal Cognitive Assessment,MoCA)평개인지공능.채용억욱자평량표화한밀이돈초필량표배제억욱화초필환자.근거MoCA총분장환자분위인지손해조화인지공능정상조,비교량조인구통계학화림상자료.채용다변량logistic회귀분석학정인지손해적독립위험인소.대LI화WML적인지손해특정진행비교.결과 공납입130례LI혹WML환자.기중,92례존재인지손해,38례인지공능정상;85례존재LI,45례존재WML;남성53례,녀성77례.단변량분석현시,인지손해조수교육년한[(7.54±4.65)년대(11.29±3.17)년;t=4.286,P=0.001]현저성저우인지정상조,이고혈압(54.6％대16.2％;x2=4.477,P=0.018)、고지혈증(53.1％대16.2％;x2=5.263,P =0.044)、당뇨병(46.9％대10.8％;x2=3.827,P=0.017)이급LI(43.8％대21.5％;x2=3.928,P=0.015)화WML(26.9％대7.7％;x2=4.072,P=0.009)적구성비현저성고우인지정상조.다변량logistic회귀분석현시,수교육년한[우세비(odds ratio,OR)1.305,95％가신구간(confidence interval,CI)1.104 ～7.975;P=0.001]、당뇨병(OR 1.328,95％ CI 1.292～3.422;P=0.015)、고혈압(OR1.978,95％CI1.034～5.443;P=0.028)、LI(OR 1.224,95％ CI1.004 ～2.007;P=0.013)화WML(OR 1.489,95％ CI 1.202～3.778;P=0.010)시인지손해적독립위험인소.WML조MoCA총분[(21.61±5.33)분대(19.19±7.07)분;t=1.841,P=0.038]이급립방체복제[(0.43±0.50)분대(0.31 ±0.47)분;t=1.104,P=0.010]、화종실험[(2.53 ±0.89)분대(2.04±1.22)분;t=2.229,P=0.008]、자모변별[(0.85±0.36)분대(0.62±0.50)분;t=2.585 P=0.000]화100련속감7[(2.62±0.79)분대(2.19±1.17)분;=2.113;P=0.001]득분균현저성저우LI조.결론 LI화WML환자균상반유인지손해,이차WML환자적인지손해교중.수교육년한、고혈압병화당뇨병시LI화WML환자발생인지손해적독립위험인소.WML환자적시공간집행공능화주의력손해교LI환자경명현.
Objective To investigate the features and its risk factors for cognitive impairment in patients with lacunar infarct (LI) and white matter lesion (WML).Methods The inpatients with LI and WML aged 65 to 75 years old were enrolled.Their demographic and clinical data were collected.LI and WML were diagnosed by magnetic resonance imaging (MRI).Montreal Cognitive Assessment Scale (MoCA) was used to evaluate cognitive function.Self-Rating Depression Scale and Hamilton Anxiety Scale were used to exclude patients with depression and anxiety.The patients were divided into either a cognitive impairment group or a normal cognitive function group.The demographic and clinical data of both groups were compared.Multivariate logistic regression analysis was used to analyze and determine the independent risk factors for cognitive impairment.The characteristics of cognitive impairment of LI and WML were compared.Results A total of 130 patients with LI or WML were enrolled,92 of them had cognitive impairment,and 38 had normal cognitive function; 85 had LI,and 45 had WML; 53 were males and 77 were females.Univariate analysis showed that years of education in the cognitive impairment group (7.54 ±4.65 years vs.11.29 ±3.17 years; t =4.286,P=0.001) was significantly lower than that of the normal cognitive function group,while the constituent ratios of hypertension (54.6％ vs.16.2％ ;x2 =4.477,P =0.018),hyperlipidemia (53.1％ vs.16.2％ ;x2 =5.263; P =0.044),diabetes mellitus (46.9％ vs.10.8％;x2 =3.827,P=0.017),as well as LI (43.8％ vs.21.5％;x2 =3.928,P=0.015) and WML (26.9％ vs.7.7％ ;x2 =4.072,P =0.009) were significantly higher than those of the normal cognitive function group.Multivariate logistic regression analysis showed that years of education (odds ratio [OR],1.305,95％confidence interval [CI] 1.104-7.975; P =0.001),diabetes mellitus (OR 1.328,95％ CI 1.292-3.422;P =0.015),hypertension (OR 1.978,95％ CI 1.034-5.443; P =0.028,LI (OR 1.224,95％ CI 1.004-2.007; P =0.013),and WML (OR 1.489,95％ CI 1.202-3.778; P =0.010) were the independent risk factors for cognitive impairment.The total MoCA score (21.61 ± 5.33 vs.19.19 ± 7.07; t =1.841,P =0.038) and cube copy (0.43 ± 0.50 vs.0.31 ± 0.47; t =1.104,P =0.010),clock drawing test (2.53 ±0.89 vs.2.04 ± 1.22; t =2.229,P =0.008),letters identification (0.85 ±0.36 vs.0.62 ±0.50; t =2.585,P==0.000),and 100 minus 7 consecutively (2.62 ±0.79 vs.2.19 ± 1.17; t =2.113; P=0.001) of the WML group were significantly lower than those of the LI group.Conclusions The patients with LI and WML often had cognitive impairment,and the cognitive impairment in patients with WML was more serious.Years of education,hypertension and diabetes were the independent risk factors for cognitive impairment in patients with LI and WML.Visuospatial executive function and attention damage in patients with WML were severer than those of the patients with LI.
