老年高血压病患者认知功能与脑室周围脑白质疏松程度的关系

Relationship of cognitive function with severity of periventricular leukoaraiosis in elderly patients with hypertension

目的探讨老年高血压病患者认知功能与磁共振（MRI）显示脑室周围脑白质疏松（LA）程度的关系。方法以90名年龄在60岁以上的上海地区离休干部为研究对象，根据患者血压及认知功能的情况将其分为3组：正常血压无认知功能障碍组（A组）、高血压病无认知功能障碍组（B组）、高血压病合并认知功能障碍组（C组），每组30例受试者。根据如下因素进行3组患者分别配对：年龄段、性别、民族、居住地、受教育年限、是否伴有2型糖尿病。对入选患者进行认知功能量表测定及头颅MRI检查，检查后由两名有经验的医师独立在工作站进行MRI读片，对脑室周围LA程度进行评分，并分析该评分与受试者血压及认知功能障碍的关系。结果3组患者脑室旁LA评分比较，差异有统计学意义（c2＝-26.874，P＜0.001）。进一步进行两两比较，A组与B组（c2＝-10.506，P＝0.033）、B组与C组（c2＝-10.029，P＝0.040）、A组与C组（c2＝-25.112，P＜0.001）两组间LA评分差异均有统计学意义。LA评分在高血压病合并认知功能障碍的患者中明显增高。结论存在认知功能障碍的老年高血压病患者常有LA影像学表现，可考虑将LA评分作为老年高血压病患者认知功能障碍的早期临床诊断依据之一。

Objective To investigate the relationship of cognitive function and the severity of periventricular leukoaraiosis （LA） by magnetic resonance imaging （MRI） in the elderly suffering from hypertension. Methods A total of 90 veteran cadres （≥60 years old） living in Shanghai city were subjected in this study, and were equally divided into 3 groups： Group A （normotension and normal cognitive function）, Group B （hypertension and normal cognitive function）, and group C（hypertension and impaired cognitive function）. All subjects in the 3 groups were matched one to one, according to the following factors： age, gender, nationality, place of residence, years of education, and with type 2 diabetes or not. All subjects were assessed by the questionnaires of Mini-Mental State Examination （MMSE）, Montreal Cognitive Assessment （MoCA） and Activity of Daily Living （ADL） for the prevalence rate of cognitive function impairment. Head MRI were operated in these patients, and 2 experienced physicians scored the periventricular white matter lesion in separated workstations independently. The correlation of the LA scores was analyzed with hypertension and cognitive function impairment. Results There were significant differences in the periventricular LA score among the 3 groups （Chi square=-26.874, P〈0.001）. Pairwise comparison showed that significant differences were also found in the score between 2 of these groups, that is, between Group A and Group B （Chi square=-10.506, P=0.033）, Group B and Group C（Chi square=-10.029, P=0.040）, and Group A and Group C （Chi square=-25.112, P〈0.001）. LA scores were increased significantly in the elderly with hypertension and cognitive impairment. Conclusion The elderly patients with hypertension and cognitive impairment usually are manifested as LA in MRI. LA score might be considered as one of early diagnostic indications of hypertensive patients with cognitive dysfunction.