脑小血管病与轻度认知功能障碍的关系

Relationship between cerebral small vessel disease and mild cognitive impairment

目的探讨脑小血管病变（SVD）与轻度认知功能障碍（MCI）的关系。方法收集临床SVD相关的MCI（SVD-MCI）患者66例和认知功能正常的老年人57例作为对照组。根据视觉评分,评估白质病变（WML）和内侧颞叶萎缩（MTA）病变的程度,并记录大脑不同部位腔隙性梗死（LI）的数目,应用多元Logistic回归分析LI、WML和MTA与SVD-MCI之间的相关性。结果①与对照组相比,SVD-MCI组患者患高血压比例和血中TC含量明显升高（P〈0.05）;吸烟、患糖尿病的比例和血中总胆固醇、低密度脂蛋白胆固醇含量有所升高,但差异无统计学意义（P〉0.05）;②与对照组相比,SVD-MCI组患者丘脑、侧脑室周围白质和皮质下白质LI的数目明显增加（P〈0.05）;SVD-MCI组患者侧脑室周围和皮质下WML以及双侧MTA评分分值也显著增加（P〈0.05）;③控制了年龄和多种血管危险因素的影响之后,多元Logistic回归分析显示,丘脑LI、侧脑室旁WML和左侧MTA与SVD-MCI相关。结论丘脑LI、侧脑室旁WML和左侧MTA可能是SVD-MCI的独立危险因素,积极预防和治疗SVD,也许可降低MCI的发生率。

Objective To investigate the relationship between cerebral small vessel disease （SVD） and mild cognitive impairment （MCI）. Methods A total of 66 patients with SVD-related MCI （SVD- MCI） were recruited in clinical practice, and 57 old subjects with normal cognition （NC） were used as controls. The severity of white matter lesions （WML） and medial temporal lobe atrophy （MTA） was as- sessed using a visual scoring method, and the numbers of lacunar infarction （LI） in different regions of the brain were recorded. The correlation between LI, WML, MTA and MCI was analyzed by multiple logistic regression analysis. Results （1）As compared with the SVD-NC group, the proportion of hypertension and blood total cholesterol （ TC ） concentration in the SVD-MCI group were increased significantly （ P 〈 0.05 ） ; the proportion of smokers, diabetes mellitus, blood triglyceride （TG） and low-density fipoprotein cholesterol （LDL-C） concentration were increased slightly, but there were no significant differences （P 〉 0.05 ）. （2）As compared with the SVD-NC group, the numbers of LI in thalamus, periventricular white matter and subcortical white matter were increased significantly （ P 〈 0.05 ） ; Scores of periventricular and subcortical WML and bilateral MTA in the SVD-MCI group were also increased significantly （P 〈 0.05）. （3）After controlling the impact of age and various vascular risk factors, the multiple logistic regression analysis showed that thalamic LI, WML beside the lateral ventricle and left MTA were associated with SVD-MCI. Conclusion Thalamic LI, WML beside the lateral ventricle and left MTA may be the independent risk factors for SVD-MCI. Active prevention and treatment of SVD may reduce the occurrence of MCI.