颈动脉粥样硬化对轻度认知功能损害的影响

Effect of carotid atherosclerosis on mild cognitive impairment

目的探讨颈动脉粥样硬化对轻度认知功能损害（mild cognitive impairment，MCI）的影响。方法2006年11月至2007年9月单纯随机抽选1886名广州市50岁或以上，自报未患有脑卒中、心肌梗死、肺心病及恶性肿瘤等重大慢性疾病的相对健康的中老年人进行MCI测试和颈动脉彩色超声多普勒检查，以简易精神状态检查（Mini Mental State Examination，MMSE）及10个单词延迟记忆测试（10-word list learning task，CWL）得分和颈总动脉内膜一中膜厚度（IMT）作为评价指标。结果（1）本研究共检出MCI300例，患病率为15．9％。男女之间患病率差异无统计学意义。（2）CWI。得分随年龄、吸烟率、收缩压、腹围和低密度脂蛋白的升高而降低，随教育程度、体力活动和高密度脂蛋白上升而增加；而MMSE则与吸烟、体力活动、腹围和脂蛋白水平无明显相关。（3）在校正了多种潜在混杂因素后，IMT的增加均与CWL（β=-1．05，95％CI：-1．73～-0．36）和MMSE分数（p=-0．95，95％CI：-1．67～-0．23）的下降呈线性相关（P〈0．01）。（4）在校正了年龄、性别、教育、运动、吸烟、腹围、收缩压和高密度及低密度脂蛋白后，MCI患者相对非MCI者的平均IMT显著增加（0．76mm与0．74mm，F=6．9，P〈0．01）。结论颈动脉IMT增加与MCI的严重程度呈线性相关，与MCI的发生、发展关系密切。

Objective To examine the effect of carotid atherosclerosis on mild cognitive impairment （MCI）. Methods 1886 relatively healthy Guangzhou residents without history of stroke, myocardial infarction, pulmonary heart disease and malignant tumor were recruited in this study by simple random selection. MCI and carotid color ultrasound were measured in these subjects by using the Mini Mental State Examination （MMSE）, the 10-word list learning task （CWL） and common carotid artery intima-medial thickness （IMT） as iudicators. Results （ 1 ） The 300 （ 15.9% ） subjects with MCI were identified. No significant difference in MCI prevalence between the sexes was identified. （2） Significant associations between CWL and traditional cardiovascular risk factors, such as older age, smoking and increased waist circumference, blood pressure and lipids were found. increasing IMT was significantly associated with both 0.36） and MMSE score （[？,= -0.95,95% CI （ 3 ） After adjusting for multiple potential confounders, decreased CWL （ β = - 1.05, 95% CI： - 1.73- 1.67--0. 23）. （4） After adjusting for age, sex, education, physical activity, smoking, waist circumference and high- and low-density lipoprotein cholesterol, IMT was significantly thicker in the MCI group than the normal （0. 76 mm vs 0. 74 mm, F = 6. 9,P 〈0. 01 ）. Conclusions The severity of MCI was significantly and linearly associated with increased IMT, suggesting that preventing atherosclerosis may help to reduce the incidence and development of dementia.