缺血性脑小血管病患者轻度认知障碍的危险因素和临床特征：回顾性病例系列研究

Risk factors and clinical features of mild cognitive impairment in patients with ischemic cerebral small vessel disease： a retrospective case series study

目的探讨缺血性脑小血管病（smallvesseldisease，SVD）患者轻度认知障碍（mildcoglitiveimpairment，MCI）的危险因素和临床特征，为早期诊断和早期干预提供依据。方法应用蒙特利尔认知评估量表（MontrealCognitiveAssessment，MoCA）筛查MCI，收集相关危险因素和其他临床资料，并进行其他神经心理学测试。根据MRI表现将SVD分为脑白质疏松（1eukoaraiosis，LA）、腔隙性梗死（1acunarinfarction，L1）和LA与LI并存（LA—LI）3种类型。结果共纳入143例SVD患者，其中MCl组68例，非MCI组75例。单变量分析显示，MCI组年龄、性别构成比与非MCI组无显著差异，但MCI组受教育年限显著短于非MCI组，而高血压（69．11％对45．33％；x2=8．215，P=0．004）、糖尿病（57．35％对40．00％；X2=4．301，P=0．038）、高脂血症（48．53％对24．00％；X2=9．352，P=0．002）、颈动脉粥样硬化（41．18％对21．33％；X2=6．592，P：0．010）和吸烟（32．35％对14．67％；X2=6．285，P=0．012）的构成比以及尿酸[（351．81±83．21）mmol／L对（323．03±80．43）mmol／L；t=2．102，P=0．037]和总胆固醇[（5．26±1．26）mmol／L对（4．56±1．23）mmol／L；t=3．326，P=0．001]水平显著高于非MCI组。多变量logistic回归分析显示，高血压[优势比（oddsratio，OR）2．227，95％可信区间（confidenceinterval，CI）1．001～4．954；P=0．026]、糖尿病（OR2．056，95％C11．862～4．937；P=0．046）、高脂血症（OR2．528，95％C11．361～5．770；P：0．028）、颈动脉粥样硬化（OR2．658，95％CI1．110～6．367；P=0．029）、吸烟（OR2．566，95％CI1．017～6．474；P=0．046）和受教育年限（OR0．825，95％C10．745～0．914；P=0．000）是SVD患者出现MCI的独立危险因素。MCI组MoCA总分[（18．44±5．60）分对（27．09±1．37）分；t=-12．422，P=0．000]以及视空间／执行能力[（2．65±1．39）分对（4．49±0．74）分；t=-9．762，P；0．000]、注意力[（4．48±1．70）分对（5．89±0．31）分；t：6．706，P：0．000]、语言[（1．69±0．80）分对（2．41±0．95）分；t=4．893，P=0．018]、抽象能力[（0．85±0．69）分对（1．71-1-0．53）分；t=-7．081，P=0．000]、延迟回忆[（1．29±1．01）分对（4．04±0．99）分；t=13．824，P=0．000]等亚项得分均显著低于非MCI组，而命名和定向力得分无显著差异。在MCI组中，LA—LI组MoCA总分[（17．04±6．15）分对（21．04±3．98）分；P〈0．05]以及视空间／执行功能[（1．68±1．16）分对（3．24±1．13）分；P〈0．05]、注意力[（3．92±2．03）分对（5．19±0．87）分；P〈0．05]、延迟回忆[（1．35±1．01）分对（1．86±1．58）分；P〈0．05]等亚项得分显著低于LI组；LA组MoCA总分[（18．18±5．31）分对（21．04±3．98）分；P〈0．05]以及视空间／执行功能[（2．56±1．78）分对（3．24±1．13）分；P〈0．05]、语言[（0．64±0．23）分对（1．24±0．83）分；P〈0．05]、延迟回忆[（0．69±0．58）分对（1．86±1．58）分；P〈0．01]等亚项得分显著低于LI组；LA—LI组视空间／执行功能评分显著低于LA组[（1．68±1．16）分对（2．56±1．78）分；P〈0．05]和u组[（1．68±1．16）分对（3．24±1．13）分；P〈0．05]。结论高血压、糖尿病、高脂血症、颈动脉粥样硬化、吸烟和受教育水平较低是SVD患者MCI的独立危险因素。SVD后MCI的认知损害表现为包括视空间／执行功能、延迟回忆在内的多个认知域损害，不同类型脑小血管病之间的认知损害有所不同。

Objective To investigate the risk factors and clinical features of mild cognitive impairment （MCI） in patients with ischemic cerebral small vessel disease （SVD） for early diagnosis and prevention. Methods Montreal Cognitive Assessment Scale （MoCA） was used to screen MCI. The related risk factors and other clinical data were collected, and other neuropsychological tests were conducted. SVD was divided into leukoaralosis （LA）, lacunar infarction （LI）, and LA ＋ LI. Results A total of 143 patients with SVD were enrolled （68 in an MCI group, 75 in a non-MCI group）. Univariate analysis showed that there was no significant difference in the constituent ratio of age and gender between the MCI group and the non-MCI group, but the years of education in the MCI group was shorter than that in the non-MCI group, while the composition ratios of hypertension （69. 11% vs. 45. 33 % ;X2 = 8. 215, P = 0. 004）, diabetes （57. 35% vs. 40. 00% ; X2 = 4. 301, P = 0. 038 ）, hyperlipidemia （48. 53% vs. 24. 00% ; X2 = 9. 352, P = 0. 002 ）, carotid atherosclerosis （41.18% vs. 21.33% ;X2 =6. 592, P =0. 010）, and smoking （32. 35% vs. 14. 67% ;X2 =6. 285, P =0. 012）, as well as the levels of uric acid （351.81± 83.21 mmol/L vs. 323.03 ±80. 43 mmol/L; t = 2. 102, P = 0. 037） and total cholesterol （5.26± 1.26 mmol/L vs. 4. 56 ± 1.23 mmol/L; t = 3. 326, P = 0. 001） were significantly higher than those in the non-MCI group. Multivariate logistic regression analysis showed that hypertension （odds ratio OR] 2. 227, 95% confidence interval [ CI], 1. 001 -4. 954; P =0. 026）, diabetes （OR 2. 056, 95% CI 1. 862 -4. 937; P =0. 046）, hyperlipidemia （OR 2. 528, 95% CI 1. 361 - 5. 770; P =0. 028）, carotid atherosclerosis （OR 2. 658, 95% CI 1. 110 -6. 367; P =0. 029）, smoking （OR 2. 566, 95% CI 1. 017 - 6. 474; P = 0. 046）, and years of education （OR 0. 825, 95% CI 0. 745 - 0. 914; P = 0. 000） were the independent risk factors for the occurrence of MCI in patients with SVD. The subscores in the MCI group, includingMoCA total score （18.44 ± 5.60 vs. 27. 09 ±1.37; t= -12.422; P=0.000）, as well as visuoconstructional skills （2. 65 ± 1.39 vs. 4.49 ±0 . 74; t = - 9. 762; P = 0. 000）, attention （4.48 ± 1.70vs. 5. 89 ± 0. 31; t = 6. 706, P=0.000）,language （1.69 ± 0.80vs. 2. 41 ± 0. 95;t=4.893, P= 0.018）, abstraction （0.85 ± 0.69vs. 1.71 ± 0.53; t= -7.081, P=0.000）, delayed recall （1.29± 1.01 vs. 4. 04± 0. 99; t = 13. 824, P =0. 000） were significantly lower than those in the non-MCI group, and there were no significant differences in naming and orientation scores. In the MCI group, the subscores such as the MoCA total score in the LA＋ LI group （17.04 ±6. 15 vs. 21.04 ± 3.98; P〈 0.05）, as well as visuoconstructional skills （1.68 ± 1. 16 vs. 3.24 ± 1.13; P〈0. 05）, attention （3.92 ± 2. 03 vs. 5.19 ± 0. 87; P 〈0. 05）, delayed recall （1.35 ± 1.01 vs. 1.86 ±1.58; P 〈0. 05） were significantly lower than those in the LI group; the subscores such as the MoCA total score in the LA group （18. 18 ± 5.31 vs. 21.04 ± 3.98; 〈 =0.05）, as well as visuoconstructional skills （2.56 ±1.78 vs. 3.24 ±1.13; P〈0.05）, language （0.64 ± 0.23 vs. 1.24 ±0.83;P〈0.05）,delayedrecallO. 69 ± 0.58vs. 1.86 ±1.58;P〈0.01）were significantly lower than those in the LI group; the visuoconstmctional skills in the LA ＋ LI group was significantly lower than that in the LA group （1.68 ±1.16 vs. 2. 56 ± 1.78; P〈0. 05） and the LI group （1.68 ± 1.16 vs. 3.24± 1.13; P〈 0. 05）. Conclusions Hypertension, diabetes, hyperlipidemia, carotid atherosclerosis, smoking and the low level of education were the independent risk factors for MCI in patients with SVD. After SVD, the cognitive impairment in MCI presented as multiple cognitive domains impairments, including visuoconstructional skills and delayed recall. Cognitive impairment differed among the different types of SVD.