高血压病合并不同类型脑小血管病与认知功能障碍的关系

Relationship between hypertension with different types of cerebral small vessel disease and cognitive impairment

目的:探讨高血压病合并不同类型脑小血管病(CSVD)与认知功能障碍的关系,及其可能机制。方法:收集168例高血压病合并CSVD住院患者的临床资料,CSVD分为腔隙性脑梗死、脑白质变性和脑微出血3种类型。根据其(VCI)程度将患者分为无VCI(NVCI)组(99例)和非痴呆性VCI(VCIND)组(69例),比较2组病例简易精神状态量表(MMSE)评分的差异,并检测2组患者血清白介素1(IL-1)、IL-6、IL-10及高迁移率族蛋白(HMGB1)的水平,研究其发病机制。结果:VCIND组MMSE评分明显低于NVCI组[(16.20±3.35)分vs(29.40±5.74)分,t=13.650,P<0.05];而各组内3种不同类型CSVD MMSE评分比较,差异无统计学意义(均P>0.05)。与NVCI组比较,VCIND组血清IL-1、IL-6、HMGB1水平显著升高(均P<0.05),而IL-10水平比较差异无统计学意义(P>0.05)。结论:高血压病合并不同类型CSVD人群发生VCIND可能与高细胞炎症反应相关。

Objective:To investigate the relationship between hypertension with different types of cerebral small vessel disease(CSVD)and cognitive impairment and the possible mechanism.Methods:Clinical data of 168 patients diagnosed with hypertension complicated with CSVD were collected,and divided into three types:lacunar cerebral infarction,white matter degeneration and cerebral microbleeds.According to the degree of the vascular cognitive impairment(VCI),the patients were divided into the non-VCI(NVCI)group(99 cases)and the non-dementia VCI(VCIND)group(69 cases).The difference in the MMSE score between two groups was compared.Serum levels of inflammatory cytokines[interleukinIL-1,IL-6,IL-10,and high-mobility group protein 1(HMGB1)]in the two groups were determined to investigate the pathogenesis.Results:MMSE score in VCIND group was significantly lower than that in NVCI group[(16.20±3.35)vs(29.40±5.74),t=13.650,P<0.05].There was no difference in MMSE scores among three types of CSVD in two groups(all P>0.05).The levels of IL-1,IL-6 and HMGB1 in the VCIND group were significantly higher than those in the NVCI group(all P<0.05),while the level of IL-10 in the two groups showed no significant difference(P>0.05).Conclusion:The occurrence of VCIND in hypertensive patients with different types of CSVD might be related to the hypercellular inflammatory response.