小血管闭塞性卒中患者认知功能与脑微出血的相关性——前瞻性病例系列研究

Correlation between cognitive function and cerebral microbleeds in patients with small-artery occlusive stroke A prospective case series study

目的探讨小血管闭塞性卒中（small artery occlusion，SAO）患者认知功能损害与脑微出血（cerebral microbleed，CMB）的相关性。方法：选择南京卒中注册系统2011年1月至2011年5月期间的SAO患者，应用蒙特利尔认知评价量表（Montreal Cognitive Assesment，MoCA）进行认知评价，同时行常规序列MRJ以及磁敏感加权成像（susceptibility-weighted imaging,SWI）检测CMB。结果共纳入SAO患者70例，其中MoCA评分异常（〈26分）者48例，MoCA评分正常（≥26分）者22例。患者年龄（t=-2．237，P=0．023）、受教育年限（t=2．297，P=0．025）、高血压史（X^2=2．297，P=0．029）、白质病变程度（Z=-3．263，P=0．001）和存在CMB（P=0．001）与SAO患者MoCA评分异常有关。Logistic回归分析表明，在校正年龄、性别、白质病变以及高血压、糖尿病和冠心病史后，存在CMB（优势比5．648，95％可信区间1．105～28．869；p=0．038）仍然是MoCA评分异常的独立危险因素。CMB程度越严重，MoCA评分越低（r=-0．532，P〈0．001）。在CMB患者中，MoCA总分（t：5．180，P〈0．001）、视空间／执行功能（t=3．924，P〈0．001）与注意力（t=4．309，P〈0．001）等认知领域显著受损，不同部位CMB可导致相关领域的认知功能损伤。结论CMB数量和部位与SAO患者的认知功能损害密切相关。

Objective To investigate the correlation between cognitive function and cerebral microbleeds （CMBs） in patients with small artery occlusive stroke （SAO）. Methods The patients with SAO in Nanjing Stroke Registration Program were recruited from January 2011 to May 2011. The Montreal Cognitive Assessment （MoCA） was used to conduct the cognitive evaluation. At the same time, conventional MRI sequences and susceptibility-weighted imaging （SWI） were used to detect CMBs. Results A total of 70 patients with SAO were included in the study, 48 of them had abnormal MoCA scores （〈26 points） and 22 of them had normal MoCAscores （t〉26）. The age of patients （t = -2. 237, P =0. 023）, years of education （t =2. 297, P = 0. 029）, history of hypertension 0（2 = 2. 297, P = 0. 025 ）, severity of white matter hyperintensities （Z = -3.263, P =0. 001） and presence of CMBs （P =0. 001） were associated with the abnormal MoCA scores in patients with SAO. Logistic regression analysis showed that after adjusting for age, sex, white matter lesions, hypertension, diabetes and coronary heart disease, the presence of CMBs （odds ratio 5. 648,95% confidence interval 1. 105-28. 869; P = 0. 038） was still an independent risk factor for abnormal MoCA scores. The more serious of CMBs, the lower the MoCA scores （r = - 0. 532, P 〈 0. 001）. In patients with CMBs, the cognitive domain, such as the total MoCA score （t = 5. 180, P 〈 0. 001）, visuospatial/executive function （t = 3. 924, P 〈 0. 001 ） and attention （t = 4. 309, P 〈 0. 001 ） were impaired significantly. The CMBs at different parts resulted in cognitive impairment in the related fields. Conclusions The numbers of CMBs and their locations were closely associated with cognitive impairment in patients with SAO.